Provider Demographics
NPI:1164465902
Name:CLINTON COUNTY
Entity Type:Organization
Organization Name:CLINTON COUNTY
Other - Org Name:MENTAL HEALTH & ADDICTION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-565-4060
Mailing Address - Street 1:130 ARIZONA AVE STE 1500
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-4908
Mailing Address - Country:US
Mailing Address - Phone:518-565-4060
Mailing Address - Fax:518-566-0168
Practice Address - Street 1:130 ARIZONA AVE STE 1500
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-4908
Practice Address - Country:US
Practice Address - Phone:518-565-4060
Practice Address - Fax:518-566-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05727101YA0400X
NY685511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00672046Medicaid
NY53193AMedicare ID - Type Unspecified