Provider Demographics
NPI:1366597171
Name:CATHOLIC CHARITIES OF CORTLAND COUNTY
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF CORTLAND COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-756-5992
Mailing Address - Street 1:33 35 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2601
Mailing Address - Country:US
Mailing Address - Phone:607-756-5992
Mailing Address - Fax:607-756-5999
Practice Address - Street 1:33 35 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2601
Practice Address - Country:US
Practice Address - Phone:607-756-5992
Practice Address - Fax:607-756-5999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE OF SYRACUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-24
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01305086Medicaid
NY01065723Medicaid