Provider Demographics
NPI:1326015553
Name:GREENE COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:GREENE COUNTY PUBLIC HEALTH
Other - Org Name:EARLY INTERVENTION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SERVICES FOR CHILDREN W
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:518-719-3617
Mailing Address - Street 1:411 MAIN ST
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 ST.
Practice Address - Street 2:3RD FLOOR
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:2006-03-07
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1952600251K00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03003743Medicaid