Organization
COUNTY OF ORANGE
Active
Other names
Port Jervis Clinic, County of Orange, Department of Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
INDIRA SMITH (PROGRAM EVALUATION ASSISTANT)
(845) 291-2902
Entity
Organization
Contact information
Practice address
146 PIKE STREET, PORT JERVIS, NY 12771
(845) 858-1456
(845) 858-1459
Mailing address
30 HARRMAN DRIVE, GOSHEN, NY 10924
(845) 291-2600
(845) 291-2628
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
7201109A
NY
261QM0850X
Adult Mental Health Clinic/Center
7201109A
NY
261QM0855X
Adolescent and Children Mental Health Clinic/Center
7201109A
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00542503
—
NY
05
—
03004253
—
NY
Enumeration date
06/01/2006
Last updated
07/08/2021
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