Provider Demographics
NPI:1376301390
Name:CHARLENE M. CROSS LICENSED CLINICAL SOCIAL WORKER PLLC
Entity Type:Organization
Organization Name:CHARLENE M. CROSS LICENSED CLINICAL SOCIAL WORKER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-321-5369
Mailing Address - Street 1:260 KINGS MALL CT STE 177
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1574
Mailing Address - Country:US
Mailing Address - Phone:585-481-5270
Mailing Address - Fax:
Practice Address - Street 1:260 KINGS MALL CT STE 177
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1574
Practice Address - Country:US
Practice Address - Phone:585-481-5270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty