Provider Demographics
NPI:1326105446
Name:MENTAL HEALTH ASSOCIATION OF ROCKLAND COUNTY, INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF ROCKLAND COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:845-267-2172
Mailing Address - Street 1:140 ROUTE 303
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-5906
Mailing Address - Country:US
Mailing Address - Phone:845-267-2172
Mailing Address - Fax:845-267-2169
Practice Address - Street 1:140 ROUTE 303
Practice Address - Street 2:SUITE A
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-5906
Practice Address - Country:US
Practice Address - Phone:845-267-2172
Practice Address - Fax:845-267-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01304585Medicaid
NY01308947Medicaid
NY02760025Medicaid
NY02995191Medicaid
NY00304985Medicaid
NY01237425Medicaid
NYW02621Medicare PIN