Provider Demographics
NPI:1255917043
Name:CENTRAL ADIRONDACK COUNSELING LCSW PLLC
Entity type:Organization
Organization Name:CENTRAL ADIRONDACK COUNSELING LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSWR
Authorized Official - Prefix:
Authorized Official - First Name:TACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:518-307-9292
Mailing Address - Street 1:60 MELDON CIR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-5857
Mailing Address - Country:US
Mailing Address - Phone:518-307-9292
Mailing Address - Fax:518-615-5801
Practice Address - Street 1:333 GLEN ST STE 100
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3578
Practice Address - Country:US
Practice Address - Phone:518-307-9292
Practice Address - Fax:518-615-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1992101505OtherNPI