Provider Demographics
NPI:1578837290
Name:PSYCHIATRIC SERVICE OF ORANGE & SULLIVAN
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICE OF ORANGE & SULLIVAN
Other - Org Name:PSOR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDEN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-469-3621
Mailing Address - Street 1:20 WEST AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1032
Mailing Address - Country:US
Mailing Address - Phone:845-469-3621
Mailing Address - Fax:845-469-3618
Practice Address - Street 1:20 WEST AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1032
Practice Address - Country:US
Practice Address - Phone:845-469-3621
Practice Address - Fax:845-469-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191640103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01389931Medicaid
NY01389931Medicaid