Provider Demographics
NPI:1407280225
Name:SOUTHERN TIER SPECIAL NEEDS RESOURCES LLC
Entity Type:Organization
Organization Name:SOUTHERN TIER SPECIAL NEEDS RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:607-206-4799
Mailing Address - Street 1:38 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-3016
Mailing Address - Country:US
Mailing Address - Phone:607-206-4799
Mailing Address - Fax:607-797-7601
Practice Address - Street 1:38 MARGARET ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-3016
Practice Address - Country:US
Practice Address - Phone:607-206-4799
Practice Address - Fax:607-797-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health