Provider Demographics
NPI:1972392074
Name:CLUTCH NP IN PSYCHIATRY AND COMMUNITY HEALTH PC
Entity type:Organization
Organization Name:CLUTCH NP IN PSYCHIATRY AND COMMUNITY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFIX
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP, FNP
Authorized Official - Phone:347-257-6706
Mailing Address - Street 1:518 AUDUBON PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1208
Mailing Address - Country:US
Mailing Address - Phone:347-257-6706
Mailing Address - Fax:
Practice Address - Street 1:518 AUDUBON PKWY
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1208
Practice Address - Country:US
Practice Address - Phone:347-257-6706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health