Provider Demographics
NPI:1952836470
Name:SOUTHERN DUTCHESS BEHAVIORAL GROUP LLC
Entity Type:Organization
Organization Name:SOUTHERN DUTCHESS BEHAVIORAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:845-632-2939
Mailing Address - Street 1:1285 ROUTE 9 STE 7B
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4993
Mailing Address - Country:US
Mailing Address - Phone:845-632-2939
Mailing Address - Fax:845-632-2940
Practice Address - Street 1:1285 ROUTE 9 STE 7B
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4993
Practice Address - Country:US
Practice Address - Phone:845-632-2939
Practice Address - Fax:845-632-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty