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Organization
CHILDERS PROFESSIONAL SERVICE LLC
Active
Organization
CHILDERS PROFESSIONAL SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL JOSEPH CHILDERS LCSW-R (DIRECTOR)
(315) 383-7531
Entity
Organization
Contact information
Practice address
27 JOSHUA LN, CENTRAL SQUARE, NY 13036-2176
(315) 383-7531
(315) 676-0014
Mailing address
PO BOX738, BREWERTON, NY 13029
(315) 383-7531
(315) 676-0014
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0574061
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02426997
—
NY
Enumeration date
12/20/2016
Last updated
12/20/2016
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