Provider Demographics
NPI:1982037321
Name:ST LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ST LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:HATHAWAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-386-2325
Mailing Address - Street 1:80 SH 310
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13676
Mailing Address - Country:US
Mailing Address - Phone:315-386-2325
Mailing Address - Fax:
Practice Address - Street 1:80 SH 310
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1436
Practice Address - Country:US
Practice Address - Phone:315-386-2325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY458894251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare