Provider Demographics
NPI:1821001579
Name:CORTLAND COUNTY COUNTY TREASURER
Entity Type:Organization
Organization Name:CORTLAND COUNTY COUNTY TREASURER
Other - Org Name:CORTLAND COUNTY MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:607-758-6100
Mailing Address - Street 1:7 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2501
Mailing Address - Country:US
Mailing Address - Phone:607-758-6100
Mailing Address - Fax:607-758-6116
Practice Address - Street 1:7 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2501
Practice Address - Country:US
Practice Address - Phone:607-758-6100
Practice Address - Fax:607-758-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 2084P0804X, 251S00000X, 261QM0801X, 261QM0850X, 261QM0855X
NY6952100A103TC0700X, 1041C0700X
NY238550-12084P0800X
NYNYF30339-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00562890Medicaid
NY02997464Medicaid
NY041108000114OtherFIDELLAS PROVIDER ID#
NY000158890OtherEXCELLUS PROVIDER ID#