Provider Demographics
NPI:1669245627
Name:VILLAGE MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:VILLAGE MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:PRIVATERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:585-768-4655
Mailing Address - Street 1:3 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1381
Mailing Address - Country:US
Mailing Address - Phone:585-768-4655
Mailing Address - Fax:585-768-4655
Practice Address - Street 1:106 MUNSON STREET
Practice Address - Street 2:
Practice Address - City:LEROY
Practice Address - State:NY
Practice Address - Zip Code:14482
Practice Address - Country:US
Practice Address - Phone:585-768-4655
Practice Address - Fax:585-768-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty