Provider Demographics
NPI:1134224629
Name:DURHAM, MICHAEL S
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:DURHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34570 STATE HIGHWAY 10
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13782-1120
Mailing Address - Country:US
Mailing Address - Phone:607-865-7656
Mailing Address - Fax:607-865-7659
Practice Address - Street 1:34570 STATE HIGHWAY 10
Practice Address - Street 2:SUITE 5
Practice Address - City:HAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13782-1120
Practice Address - Country:US
Practice Address - Phone:607-865-7656
Practice Address - Fax:607-865-7659
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)