1134133754 NPI number — ADIRONDACK SOCIAL WORK SERVICES PC

Table of content: (NPI 1134133754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134133754 NPI number — ADIRONDACK SOCIAL WORK SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADIRONDACK SOCIAL WORK SERVICES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEALING WOODS COUNSELING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134133754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 COREYS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPPER LAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-359-2623
Provider Business Mailing Address Fax Number:
518-359-8255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 COREYS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPPER LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-359-2623
Provider Business Practice Location Address Fax Number:
518-359-8255
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEISSNER
Authorized Official First Name:
KLAUS
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
THERAPIST COOWNER PARTNER
Authorized Official Telephone Number:
518-359-2623

Provider Taxonomy Codes

  • Taxonomy code: 103TA0400X , with the licence number:  3437 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: R036992 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: R0376991 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7480610 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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