Provider Demographics
NPI:1043367535
Name:NORTH COUNTRY PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:NORTH COUNTRY PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-379-9162
Mailing Address - Street 1:80 EAST MAIN STREET
Mailing Address - Street 2:SUITE 255
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617
Mailing Address - Country:US
Mailing Address - Phone:315-379-9162
Mailing Address - Fax:315-379-9162
Practice Address - Street 1:80 EAST MAIN STREET
Practice Address - Street 2:SUITE 255
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-379-9162
Practice Address - Fax:315-379-9162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55785AMedicare UPIN
NY55765AMedicare ID - Type Unspecified