Provider Demographics
NPI:1437213097
Name:ADIRONDACK SAMARITAN COUNSELING CENTER, INC
Entity type:Organization
Organization Name:ADIRONDACK SAMARITAN COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-747-2994
Mailing Address - Street 1:15 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1001
Mailing Address - Country:US
Mailing Address - Phone:518-747-2994
Mailing Address - Fax:518-747-2996
Practice Address - Street 1:15 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1001
Practice Address - Country:US
Practice Address - Phone:518-747-2994
Practice Address - Fax:518-747-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54523AMedicare ID - Type Unspecified