Provider Demographics
NPI:1740508142
Name:ORANGE COUNTY DEPT OF MENTTAL HEALTH
Entity type:Organization
Organization Name:ORANGE COUNTY DEPT OF MENTTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOLZAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:845-291-2608
Mailing Address - Street 1:146 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1808
Mailing Address - Country:US
Mailing Address - Phone:845-858-1456
Mailing Address - Fax:845-858-1459
Practice Address - Street 1:146 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1808
Practice Address - Country:US
Practice Address - Phone:845-858-1456
Practice Address - Fax:845-858-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070519104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070519OtherSTATE LICENSE