Provider Demographics
NPI:1093851925
Name:FAMILY & CHILDREN'S SERVICE OF THE CAPITAL REGION INC.
Entity Type:Organization
Organization Name:FAMILY & CHILDREN'S SERVICE OF THE CAPITAL REGION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:RAINER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-R
Authorized Official - Phone:518-462-6531
Mailing Address - Street 1:650 WARREN STREET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-462-6531
Mailing Address - Fax:518-462-0181
Practice Address - Street 1:650 WARREN STREET
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-462-6531
Practice Address - Fax:518-462-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-03-19
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
NY54061AMedicare UPIN