Provider Demographics
NPI:1629181888
Name:COUNTY OF OSWEGO COUNCIL ON ALCOHOLISM & ADDICTIONS INC.
Entity Type:Organization
Organization Name:COUNTY OF OSWEGO COUNCIL ON ALCOHOLISM & ADDICTIONS INC.
Other - Org Name:COCOAA
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LMHC
Authorized Official - Phone:315-342-2370
Mailing Address - Street 1:283 W 2ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3812
Mailing Address - Country:US
Mailing Address - Phone:315-342-2370
Mailing Address - Fax:315-342-7570
Practice Address - Street 1:283 W 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3812
Practice Address - Country:US
Practice Address - Phone:315-342-2370
Practice Address - Fax:315-342-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY080510742251V00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251V00000XAgenciesVoluntary or Charitable
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00858186Medicaid
NY36110OtherOASAS AGENCY NUMBER