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General NPI Number Information
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NPI Number | 1467824656
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Entity Type | Organization
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Legal Business Name | ST LAWRENCE PSY CENTER
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 2155 ST RT 22B
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City | MORRISONVILLE
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State | NY
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Zip | 12962-3417
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Country | US
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Telephone | 518-563-8000
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Fax | 151-856-3900
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Provider Business Mailing Address
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Address Line | 1 CHIMNEY POINT DR
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City | OGDENSBURG
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State | NY
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Zip | 13669-2212
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Country | US
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Telephone | 315-541-2001
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Fax |
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Authorized Official
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Title or Position | INTENSIVE CASE MANAGER
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Name | MR. TIMOTHY D CAVENEE
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Credential | M.ED
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Telephone | 518-569-8990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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