MEDICARE: COUNTY OF STEUBEN

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TB0200X	Cognitive & Behavioral Psychologist
3	103TC0700X	Clinical Psychologist
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA2584	OTHER	NY	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	105427EU	OTHER	NY	PREFERRED CARE
3	112630100	OTHER	NY	ACS
4	7342561	OTHER	NY	NYSHIP/VO/RR/FHP
5	000426563	OTHER	NY	UNIVERA MH
6	7342561	OTHER	NY	GHI/BMP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	000159861	OTHER	NY	BCBS MH

NPI Number	:	1982709846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF STEUBEN

Provider Business Mailing Address
First Line	:	115 LIBERTY ST
Second Line	:
City	:	BATH
State	:	NY
Zip	:	14810-1508
Country	:	US
Telephone Number	:	607-664-2255
Fax Number	:	607-664-2162

Provider Business Practice Location Address
First Line	:	115 LIBERTY ST
Second Line	:
City	:	BATH
State	:	NY
Zip	:	14810-1508
Country	:	US
Telephone Number	:	607-664-2255
Fax Number	:	607-664-2162

Authorized Official
Title or Position	:	DIRECTOR OF COMMUNITY SERVICES
Name	:	DR. HENRY W. CHAPMAN
Credential	:	PSY.D.
Telephone Number	:	607-664-2255

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/31/2016