Provider Demographics
NPI:1003869165
Name:SCHUYLER COUNTY MENTAL HEALTH
Entity Type:Organization
Organization Name:SCHUYLER COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:M SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSNO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:607-535-8282
Mailing Address - Street 1:106 S PERRY ST
Mailing Address - Street 2:STE 4
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1615
Mailing Address - Country:US
Mailing Address - Phone:607-535-8282
Mailing Address - Fax:607-535-8284
Practice Address - Street 1:106 S PERRY ST
Practice Address - Street 2:STE 4
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1615
Practice Address - Country:US
Practice Address - Phone:607-535-8282
Practice Address - Fax:607-535-8284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHUYLER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000159429OtherBLUE CROSS BLUE SHEILD
NY00357520Medicaid
NY01371457Medicaid
NY54864AMedicare PIN