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General NPI Number Information
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NPI Number | 1932316569
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Entity Type | Organization
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Legal Business Name | SUNY POTSDAM
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 44 PIERREPONT AVE. SUNY POTSDAM COUNSELING CENTER
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City | POTSDAM
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State | NY
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Zip | 13676
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Country | US
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Telephone | 315-267-2330
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Fax |
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Provider Business Mailing Address
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Address Line | 605 COUNTY ROUTE 48
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City | NORWOOD
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State | NY
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Zip | 13668-3222
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | GENA C. NELSON
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Credential | LMHC, NCC
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Telephone | 315-267-2330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 002888-1
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License Number State | NY
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