Organization
SOUTHERN TIER NURSE PRACTITIONERS IN PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLINTON GEORGE PMHDNP (PROVIDER)
(716) 489-8850
Entity
Organization
Contact information
Practice address
141 CHAUTAUQUA AVE, LAKEWOOD, NY 14750-1278
(716) 489-8850
Mailing address
141 CHAUTAUQUA AVE, LAKEWOOD, NY 14750-1278
(716) 489-8850
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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