Provider Demographics
NPI:1356472088
Name:CLINTON COUNTY
Entity Type:Organization
Organization Name:CLINTON COUNTY
Other - Org Name:CLINTON COUNTY HEALTH DEPARTMENT-EARLY INTERVENTION PROGRAM AGENCY (EI
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH FACILITY COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-565-3284
Mailing Address - Street 1:133 MARGARET ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2926
Mailing Address - Country:US
Mailing Address - Phone:518-565-4840
Mailing Address - Fax:518-565-4717
Practice Address - Street 1:133 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2926
Practice Address - Country:US
Practice Address - Phone:518-565-4798
Practice Address - Fax:518-565-4509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINTON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03004533Medicaid
NY03004533Medicaid