Provider Demographics
NPI:1649377854
Name:SAMARITAN COUNSELING CENTER OF THE MOHAWK VALLEY, INC
Entity type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF THE MOHAWK VALLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMHC
Authorized Official - Phone:315-724-5173
Mailing Address - Street 1:1612 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5425
Mailing Address - Country:US
Mailing Address - Phone:315-724-5173
Mailing Address - Fax:315-724-5323
Practice Address - Street 1:1612 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5425
Practice Address - Country:US
Practice Address - Phone:315-724-5173
Practice Address - Fax:315-724-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110153OtherEXCELLUS BLUECROSS BLUESH
NY415111OtherMVP