Provider Demographics
NPI:1558701854
Name:MARRIAGE AND FAMILY THERAPY SERVICES OF THE SOUTHERN TIER, P.C.
Entity Type:Organization
Organization Name:MARRIAGE AND FAMILY THERAPY SERVICES OF THE SOUTHERN TIER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINCENTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT, BCBA
Authorized Official - Phone:607-221-5303
Mailing Address - Street 1:1 BRICK AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-2055
Mailing Address - Country:US
Mailing Address - Phone:607-760-9520
Mailing Address - Fax:607-723-9539
Practice Address - Street 1:147 W GRAY ST
Practice Address - Street 2:SUITE 217A
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3017
Practice Address - Country:US
Practice Address - Phone:607-221-5303
Practice Address - Fax:607-723-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1084739103K00000X
NY000960106H00000X
PAMF000684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty