Basic Information
| Provider Information | |||||||||
| NPI: | 1083712913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEECOF | ||||||||
| FirstName: | RONA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SEECOF | ||||||||
| OtherFirstName: | RONA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3 FAMILY PRACTICE DRIVE | ||||||||
| Address2: | FAMILY PRACTICE CENTER | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453382562 | ||||||||
| FaxNumber: | 8453388909 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 SHOPRITE BLVD | ||||||||
| Address2: | ELLENVILLE HOSPITAL CAMPUS | ||||||||
| City: | ELLENVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456474500 | ||||||||
| FaxNumber: | 8456477632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R040642 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 00733871 | 05 | NY | MEDICAID |