=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902156136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVINGSTON COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2012
-----------------------------------------------------
Last Update Date | 11/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 MURRAY HILL DR
-----------------------------------------------------
City | MOUNT MORRIS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14510-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-243-7540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 MURRAY HILL DR
-----------------------------------------------------
City | MOUNT MORRIS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14510-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-243-7540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PUBIC HEALTH DIRECTOR
-----------------------------------------------------
Name | JENNIFER RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-243-7270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 435872-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------