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General NPI Number Information
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NPI Number | 1831145101
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Entity Type | Organization
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Legal Business Name | COUNTY OF OTSEGO
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 242 MAIN ST
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City | ONEONTA
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State | NY
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Zip | 13820-2527
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Country | US
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Telephone | 607-433-2343
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Fax | 607-433-6229
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Provider Business Mailing Address
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Address Line | 242 MAIN ST
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City | ONEONTA
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State | NY
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Zip | 13820-2527
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Country | US
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Telephone | 607-433-2343
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Fax | 607-433-6229
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Authorized Official
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Title or Position | DIRECTOR OF COMMUNITY SERVICES
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Name | MS. SUSAN A MATT
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Credential | LCSW/CASAC
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Telephone | 607-433-2343
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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 |
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License Number State |
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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 |
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License Number State |
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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 | 6635100A
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License Number State | NY
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