Provider Demographics
NPI:1003846270
Name:COUNTY OF CHENANGO
Entity Type:Organization
Organization Name:COUNTY OF CHENANGO
Other - Org Name:HARRY STACK SULLIVAN MENTAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRYN
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW
Authorized Official - Phone:607-337-1602
Mailing Address - Street 1:5 COURT ST
Mailing Address - Street 2:SUITE 42, COUNTY OFFICE BUILDING
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1695
Mailing Address - Country:US
Mailing Address - Phone:607-337-1602
Mailing Address - Fax:607-334-4519
Practice Address - Street 1:5 COURT ST
Practice Address - Street 2:SUITE 42, COUNTY OFFICE BUILDING
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1695
Practice Address - Country:US
Practice Address - Phone:607-337-1602
Practice Address - Fax:607-334-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6861100A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00581246Medicaid
NY00581246Medicaid