=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942787700
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARITY LYNN TRAINHAM MSW INTERN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2018
-----------------------------------------------------
Last Update Date | 12/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6278 PINE GROVE RD
-----------------------------------------------------
City | GLENFIELD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13343-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-771-1683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 DIETZ ST STE J
-----------------------------------------------------
City | ONEONTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13820-1865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-269-4859
-----------------------------------------------------
Fax | 315-779-1184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 122534
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------