Provider Demographics
NPI:1568789154
Name:MIDDLETOWN MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:MIDDLETOWN MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY CARE NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:845-326-8094
Mailing Address - Street 1:45 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-1912
Mailing Address - Country:US
Mailing Address - Phone:845-343-8118
Mailing Address - Fax:845-326-8155
Practice Address - Street 1:45 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-1912
Practice Address - Country:US
Practice Address - Phone:845-343-8118
Practice Address - Fax:845-326-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3068341273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit