Provider Demographics
NPI:1659443000
Name:ST. PETER'S HEALTH CARE
Entity Type:Organization
Organization Name:ST. PETER'S HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC, LMHC
Authorized Official - Phone:518-783-5381
Mailing Address - Street 1:636 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4002
Mailing Address - Country:US
Mailing Address - Phone:518-783-5381
Mailing Address - Fax:518-783-0125
Practice Address - Street 1:636 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4002
Practice Address - Country:US
Practice Address - Phone:518-783-5381
Practice Address - Fax:518-783-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000764276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit