Provider Demographics
NPI:1417987165
Name:COUNTY OF SULLIVAN
Entity Type:Organization
Organization Name:COUNTY OF SULLIVAN
Other - Org Name:SULLIVAN COUNTY DEPARTMENT OF COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TODORA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:845-292-8770
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:20 COMMUNITY LANE
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-0716
Mailing Address - Country:US
Mailing Address - Phone:845-292-8770
Mailing Address - Fax:845-292-4298
Practice Address - Street 1:20 COMMUNITY LANE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-0716
Practice Address - Country:US
Practice Address - Phone:845-292-8770
Practice Address - Fax:845-292-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12443OtherBEACON HEALTH
NY143247OtherVALUE OPTIONS
NY00398370Medicaid
NY01147777Medicaid
NY143247OtherGHI
NY00398370Medicaid