Provider Demographics
NPI:1316397623
Name:MENTAL HEALTH COUNSELING SERVICES OF NNY PLLC
Entity Type:Organization
Organization Name:MENTAL HEALTH COUNSELING SERVICES OF NNY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOBOZE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:315-268-0264
Mailing Address - Street 1:6956 STATE HIGHWAY 56
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3628
Mailing Address - Country:US
Mailing Address - Phone:315-268-0264
Mailing Address - Fax:
Practice Address - Street 1:6956 STATE HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3628
Practice Address - Country:US
Practice Address - Phone:315-268-0264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
097441-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY135665128OtherNPI