MEDICARE: HERKIMER 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	261QM0850X	Adult Mental Health Clinic/Center	6690100A	NY
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	6690100A	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	:	1720174436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERKIMER COUNTY

Provider Business Mailing Address
First Line	:	301 N WASHINGTON ST STE 2470
Second Line	:
City	:	HERKIMER
State	:	NY
Zip	:	13350-1299
Country	:	US
Telephone Number	:	315-867-1465
Fax Number	:	315-867-1469

Provider Business Practice Location Address
First Line	:	301 N WASHINGTON ST STE 2470
Second Line	:
City	:	HERKIMER
State	:	NY
Zip	:	13350-1299
Country	:	US
Telephone Number	:	315-867-1465
Fax Number	:	315-867-1469

Authorized Official
Title or Position	:	DIRECTOR OF COMMUNITY SERVICES
Name	:	MR. EDGAR ROGERS SCUDDER
Credential	:	LCSW
Telephone Number	:	315-867-1465

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/23/2007

Similar Medicare Providers

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Practice Location Address:

301 N WASHINGTON ST , SUITE 2300
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Practice Location Address:

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1003221326 — DIANE YACIUK RN, BSN
Practice Location Address:

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HERKIMER, NY
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1457845364 — MS. KELLY J SITTERLY LCSW
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1720938269 — ISABELLA ROSE BAILEY
Practice Location Address:

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Directions to “HERKIMER COUNTY ” Practice Location

Language	Start Address	Practice Location

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