Provider Demographics
NPI:1467824656
Name:ST LAWRENCE PSY CENTER
Entity Type:Organization
Organization Name:ST LAWRENCE PSY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTENSIVE CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAVENEE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:518-569-8990
Mailing Address - Street 1:1 CHIMNEY POINT DR
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-2212
Mailing Address - Country:US
Mailing Address - Phone:315-541-2001
Mailing Address - Fax:
Practice Address - Street 1:2155 ST RT 22B
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-3417
Practice Address - Country:US
Practice Address - Phone:518-563-8000
Practice Address - Fax:151-856-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service