Provider Demographics
NPI:1710923115
Name:FAMILY COUNSELING CENTER OF KEENE NEW YORK INC
Entity Type:Organization
Organization Name:FAMILY COUNSELING CENTER OF KEENE NEW YORK INC
Other - Org Name:SAMARITAN FAMILY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAVERLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSRW
Authorized Official - Phone:518-576-4557
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:10897 NYS ROUTE 9N, SUITE4
Mailing Address - City:KEENE
Mailing Address - State:NY
Mailing Address - Zip Code:12942-9998
Mailing Address - Country:US
Mailing Address - Phone:518-576-4557
Mailing Address - Fax:
Practice Address - Street 1:10897 NYS ROUTE 9N,
Practice Address - Street 2:SUITE 4
Practice Address - City:KEENE
Practice Address - State:NY
Practice Address - Zip Code:12942-9998
Practice Address - Country:US
Practice Address - Phone:518-576-4557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty