=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235269713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELAWARE COUNTY PUBLIC HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 07/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 MAIN ST
-----------------------------------------------------
City | DELHI
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13753-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-832-5200
-----------------------------------------------------
Fax | 607-832-6022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 MAIN ST
-----------------------------------------------------
City | DELHI
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13753-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-832-5200
-----------------------------------------------------
Fax | 607-832-6022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PUBLIC HEALTH DIRECTOR/EIO
-----------------------------------------------------
Name | AMANDA WALSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-832-5200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------