Provider Demographics
NPI:1528197480
Name:PUTNAM COUNTY DEPARTMENT OF HEALTH, EARLY INTERVENTION DEPT.
Entity Type:Organization
Organization Name:PUTNAM COUNTY DEPARTMENT OF HEALTH, EARLY INTERVENTION DEPT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTION ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-808-1640
Mailing Address - Street 1:1 GENEVA RD
Mailing Address - Street 2:PUTNAM COUNTY DEPARTMENT OF HEALTH, EARLY INTERVENTION
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-2339
Mailing Address - Country:US
Mailing Address - Phone:845-808-1640
Mailing Address - Fax:845-808-4092
Practice Address - Street 1:1 GENEVA RD
Practice Address - Street 2:PUTNAM COUNTY DEPARTMENT OF HEALTH, EARLY INTERVENTION
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2339
Practice Address - Country:US
Practice Address - Phone:845-808-1640
Practice Address - Fax:845-808-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01427361Medicaid