Provider Demographics
NPI:1255388989
Name:FAMILY SERVICES OF THE MOHAWK VALLEY INCE
Entity type:Organization
Organization Name:FAMILY SERVICES OF THE MOHAWK VALLEY INCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:315-735-2236
Mailing Address - Street 1:401 COLUMBIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3413
Mailing Address - Country:US
Mailing Address - Phone:315-735-2236
Mailing Address - Fax:315-735-9177
Practice Address - Street 1:401 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3413
Practice Address - Country:US
Practice Address - Phone:315-735-2236
Practice Address - Fax:315-735-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55454AMedicare ID - Type UnspecifiedAGENCY IDENTIFICATION