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General NPI Number Information
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NPI Number | 1689780546
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Entity Type | Organization
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Legal Business Name | MADISON COUNTY
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 138 NORTH COURT STREET
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City | WAMPSVILLE
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State | NY
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Zip | 13163-0608
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Country | US
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Telephone | 315-366-2327
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Fax | 315-366-2599
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Provider Business Mailing Address
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Address Line | 138 NORTH COURT STREET
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City | WAMPSVILLE
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State | NY
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Zip | 13163-0608
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Country | US
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Telephone | 315-366-2327
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Fax | 315-366-2599
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. TEISHA M COOK
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Credential | LCSW-R
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Telephone | 315-366-2327
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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 | 6873100A
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License Number State | NY
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