Provider Demographics
NPI:1659132801
Name:NORTHERN COMPASS MENTAL HEALTH
Entity Type:Organization
Organization Name:NORTHERN COMPASS MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEARTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEYDI
Authorized Official - Middle Name:TATIANA
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW/LCADC
Authorized Official - Phone:862-264-9284
Mailing Address - Street 1:212 HIGHGATE RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1436
Mailing Address - Country:US
Mailing Address - Phone:862-264-9284
Mailing Address - Fax:
Practice Address - Street 1:212 HIGHGATE RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1436
Practice Address - Country:US
Practice Address - Phone:862-264-9284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health