Provider Demographics
NPI:1629094065
Name:BROOME COUNTY MENTAL HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BROOME COUNTY MENTAL HEALTH DEPARTMENT
Other - Org Name:BROOME COUNTY COMMUNITY MENTAL HEALTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:607-778-6357
Mailing Address - Street 1:36-42 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-778-6357
Mailing Address - Fax:607-778-6189
Practice Address - Street 1:36-42 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-778-6357
Practice Address - Fax:607-778-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
NY261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000158712OtherEXCELLUS
NY325793OtherVALUE OPTIONS
NY951425OtherMVP
NY00581237Medicaid
NY3105481OtherEMPIRE
NY6923OtherCDPHP
NY6923OtherCDPHP