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General NPI Number Information
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NPI Number | 1861946154
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Entity Type | Organization
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Legal Business Name | TRACTORHEALTHSOLUTIONS LLC
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 243 BAYARD STREET # 724
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City | PORT EWEN
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State | NY
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Zip | 12466
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Country | US
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Telephone | 646-249-5767
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Fax |
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Provider Business Mailing Address
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Address Line | 243 BAYARD STREET # 724
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City | PORT EWEN
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State | NY
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Zip | 12466
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Country | US
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Telephone | 646-249-5767
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM LATIMER
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Credential | LCSW R
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Telephone | 64672495767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 080579
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 23700
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 080579
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License Number State | NY
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