Provider Demographics
NPI:1073761490
Name:DEPARTMENT OF VETERAN'S AFFAIRS
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERAN'S AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:419-625-7350
Mailing Address - Street 1:15655 STATE ROUTE 170 SUITE A
Mailing Address - Street 2:CALCUTTA/EAST LIVERPOOL CBOC VA OUTPATIENT CLINIC
Mailing Address - City:CALCUTTA
Mailing Address - State:OH
Mailing Address - Zip Code:43920
Mailing Address - Country:US
Mailing Address - Phone:330-386-4303
Mailing Address - Fax:330-386-6020
Practice Address - Street 1:15655 STATE ROUTE 170 SUITE A
Practice Address - Street 2:CALCUTTA/EAST LIVERPOOL CBOC VA OUTPATIENT CLINIC
Practice Address - City:CALCUTTA
Practice Address - State:OH
Practice Address - Zip Code:43920
Practice Address - Country:US
Practice Address - Phone:330-386-4303
Practice Address - Fax:330-386-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7493251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare