Provider Demographics
NPI: | 1619922432 |
---|---|
Name: | FAMILY SERVICES OF CHEMUNG COUNTY, INC. |
Entity Type: | Organization |
Organization Name: | FAMILY SERVICES OF CHEMUNG COUNTY, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | TERRY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SINSABAUGH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 607-733-5696 |
Mailing Address - Street 1: | 1019 E WATER ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ELMIRA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14901-3332 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 607-733-5696 |
Mailing Address - Fax: | 607-733-5486 |
Practice Address - Street 1: | 1019 E WATER ST |
Practice Address - Street 2: | |
Practice Address - City: | ELMIRA |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14901-3332 |
Practice Address - Country: | US |
Practice Address - Phone: | 607-733-5696 |
Practice Address - Fax: | 607-733-5486 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-23 |
Last Update Date: | 2023-01-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 104100000X, 106H00000X, 163W00000X, 164W00000X, 171M00000X, 175T00000X, 2084P0800X, 225C00000X, 251E00000X, 261QM0801X, 261QM0850X, 363A00000X, 363LP0808X | ||
NY | 0266L001 | 3747P1801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 175T00000X | Other Service Providers | Peer Specialist | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Group - Multi-Specialty | |
No | 251E00000X | Agencies | Home Health | Group - Multi-Specialty | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 02140729 | Medicaid | |
NY | 00362854 | Medicaid | |
NY | 00906450 | Medicaid | |
NY | 00362854 | Medicaid |