Organization
NYS OFFICE OF MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT PUCCIO (DIRECTOR, FINANCE)
(518) 473-0795
Entity
Organization
Contact information
Practice address
122 DOROTHEA DIX DR, MIDDLETOWN, NY 10940-1907
(845) 342-5511
Mailing address
44 HOLLAND AVE, ALBANY, NY 12229-0001
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
NY
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00769535
—
NY
Enumeration date
02/15/2007
Last updated
08/12/2008
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