Provider Demographics
NPI:1497737167
Name:PUTNAM FAMILY AND COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:PUTNAM FAMILY AND COMMUNITY SERVICES INC
Other - Org Name:COVECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-225-2700
Mailing Address - Street 1:1808 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512
Mailing Address - Country:US
Mailing Address - Phone:845-225-2700
Mailing Address - Fax:845-225-3207
Practice Address - Street 1:1808 ROUTE 6
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-225-2700
Practice Address - Fax:845-225-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9041100A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02073283Medicaid
NY02995857Medicaid
NYA2191995OtherOXFORD GROUP NUMBER
NY01755715Medicaid
NYWIL271OtherEMPIRE HEALTH SERVICES GR
NY3189418OtherGHI GROUP NUMBER
NYWIL271Medicare PIN
NYA2191995OtherOXFORD GROUP NUMBER