Provider Demographics
NPI:1164854683
Name:CREEKSIDE COUNSELING SERVICES
Entity Type:Organization
Organization Name:CREEKSIDE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FIORINI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, PH D
Authorized Official - Phone:315-343-3344
Mailing Address - Street 1:335 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3655
Mailing Address - Country:US
Mailing Address - Phone:315-343-3344
Mailing Address - Fax:877-522-7977
Practice Address - Street 1:335 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3655
Practice Address - Country:US
Practice Address - Phone:315-343-3344
Practice Address - Fax:877-522-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty