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Organization
MADISON COUNTY
Active
Organization
MADISON COUNTY
Active
Other names
Madison County Mental Health Department Outpatient Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TEISHA M COOK LCSW-R (DIRECTOR)
(315) 366-2327
Entity
Organization
Contact information
Practice address
138 NORTH COURT STREET, WAMPSVILLE, NY 13163-0608
(315) 366-2327
(315) 366-2599
Mailing address
138 NORTH COURT STREET, WAMPSVILLE, NY 13163-0608
(315) 366-2327
(315) 366-2599
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
6873100A
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00569860
—
NY
05
—
03004400
—
NY
Enumeration date
08/22/2006
Last updated
12/06/2019
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