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General NPI Number Information
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NPI Number | 1275082562
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Entity Type | Organization
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Legal Business Name | HUDSON MOHAWK RECOVERY CENTER INC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 1724 5TH AVE
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City | TROY
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State | NY
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Zip | 12180-3541
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Country | US
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Telephone | 518-272-3918
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Fax | 518-272-6391
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Provider Business Mailing Address
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Address Line | 1724 5TH AVE
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City | TROY
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State | NY
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Zip | 12180-3541
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Country | US
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Telephone | 518-272-3918
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Fax | 518-272-6391
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Authorized Official
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Title or Position | TROY CLINIC DIRECTOR
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Name | MRS. MARY DELORY
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Credential | CASAC
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Telephone | 518-272-3918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 30911
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License Number State | NY
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