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General NPI Number Information
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NPI Number | 1740227214
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Entity Type | Organization
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Legal Business Name | COUNTY OF ORANGE
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 146 PIKE STREET
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City | PORT JERVIS
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State | NY
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Zip | 12771
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Country | US
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Telephone | 845-858-1456
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Fax | 845-858-1459
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Provider Business Mailing Address
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Address Line | 30 HARRMAN DRIVE
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City | GOSHEN
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State | NY
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Zip | 10924
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Country | US
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Telephone | 845-291-2600
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Fax | 845-291-2628
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Authorized Official
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Title or Position | PROGRAM EVALUATION ASSISTANT
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Name | INDIRA SMITH
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Credential |
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Telephone | 845-291-2902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 7201109A
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License Number State | NY
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Taxonomy #2
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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 | 7201109A
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License Number State | NY
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Taxonomy #3
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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 | 7201109A
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License Number State | NY
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