Provider Demographics
NPI:1467555243
Name:OTSEGO COUNTY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:OTSEGO COUNTY COMMUNITY SERVICES
Other - Org Name:OTSEGO COUNTY CHEMICAL DEPENDENCIES CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW/CASAC
Authorized Official - Phone:607-433-2343
Mailing Address - Street 1:242 MAIN ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2527
Mailing Address - Country:US
Mailing Address - Phone:607-431-1030
Mailing Address - Fax:607-431-1033
Practice Address - Street 1:140 COUNTY HIGHWAY 33W
Practice Address - Street 2:SUITE 1
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-4953
Practice Address - Country:US
Practice Address - Phone:607-547-1600
Practice Address - Fax:607-547-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061110917261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00583582Medicaid