Provider Demographics
NPI:1265745798
Name:BROOME COUNTY MENTAL HEALTH
Entity type:Organization
Organization Name:BROOME COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:607-778-1152
Mailing Address - Street 1:229-231 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-2756
Mailing Address - Country:US
Mailing Address - Phone:607-778-1152
Mailing Address - Fax:607-778-1164
Practice Address - Street 1:229-231 STATE ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-2756
Practice Address - Country:US
Practice Address - Phone:607-778-1152
Practice Address - Fax:607-778-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6851100A261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00581237Medicaid