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General NPI Number Information
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NPI Number | 1538455696
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOME OF JEFFERSON COUNTY
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 211 JB WISE PL
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City | WATERTOWN
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State | NY
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Zip | 13601-2507
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Country | US
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Telephone | 315-782-7445
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Fax | 315-779-1184
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Provider Business Mailing Address
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Address Line | PO BOX 6550 1704 STATE STREET
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City | WATERTOWN
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State | NY
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Zip | 13601-6550
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Country | US
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Telephone | 315-788-7430
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Fax | 315-785-5637
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MS. MICHELLE L MONNAT
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Credential | LMHC
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Telephone | 315-788-7430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 03A2861
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 9298014A
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License Number State | NY
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