MEDICARE: CLINTON COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	05727	NY
2	101YM0800X	Mental Health Counselor	685511	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164465902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON COUNTY

Provider Business Mailing Address
First Line	:	130 ARIZONA AVE STE 1500
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-4908
Country	:	US
Telephone Number	:	518-565-4060
Fax Number	:	518-566-0168

Provider Business Practice Location Address
First Line	:	130 ARIZONA AVE STE 1500
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-4908
Country	:	US
Telephone Number	:	518-565-4060
Fax Number	:	518-566-0168

Authorized Official
Title or Position	:	DIRECTOR OF COMMUNITY SERVICES
Name	:	RICHELLE GREGORY
Credential	:
Telephone Number	:	518-565-4060

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/17/2018

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Directions to “CLINTON COUNTY ” Practice Location

Language	Start Address	Practice Location

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