Provider Demographics
NPI:1720174436
Name:HERKIMER COUNTY
Entity Type:Organization
Organization Name:HERKIMER COUNTY
Other - Org Name:HERKIMER COUNTY MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:SCUDDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-867-1465
Mailing Address - Street 1:301 N WASHINGTON ST STE 2470
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1299
Mailing Address - Country:US
Mailing Address - Phone:315-867-1465
Mailing Address - Fax:315-867-1469
Practice Address - Street 1:301 N WASHINGTON ST STE 2470
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1299
Practice Address - Country:US
Practice Address - Phone:315-867-1465
Practice Address - Fax:315-867-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6690100A261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00657658Medicaid
NY00657658Medicaid