Provider Demographics
NPI:1114056777
Name:GREENE COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:GREENE COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTION OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:518-719-3617
Mailing Address - Street 1:411 MAIN STREET
Mailing Address - Street 2:3RD FLOOR, SUITE 300
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1358
Mailing Address - Country:US
Mailing Address - Phone:518-719-3617
Mailing Address - Fax:518-719-3779
Practice Address - Street 1:411 MAIN STREET
Practice Address - Street 2:3RD FLOOR, SUITE 300
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1358
Practice Address - Country:US
Practice Address - Phone:518-719-3617
Practice Address - Fax:518-719-3779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE COUNTY PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 252Y00000X
NY1952200R251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473125Medicaid
NY00473230Medicaid