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Organization
MOUNTAIN COMMUNITY WELLNESS CENTER
Active
Organization
MOUNTAIN COMMUNITY WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY MICHAEL BROWN LCSW-R (CLINICAL DIRECTOR)
(315) 221-4381
Entity
Organization
Contact information
Practice address
210 COURT ST, SUITE 4, WATERTOWN, NY 13601-4546
(315) 221-4381
(315) 221-4382
Mailing address
210 COURT ST, SUITE 4, WATERTOWN, NY 13601-4546
(315) 221-4381
(315) 221-4382
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
061925
NY
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
01/21/2012
Last updated
01/21/2012
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