Basic Information
| Provider Information | |||||||||
| NPI: | 1588840037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | BECALLO | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BECALLO | ||||||||
| OtherFirstName: | CATHERINE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | NORTH COURT STREET, PO BOX 608 | ||||||||
| Address2: | MADISON COUNTY MENTAL HEALTH DEPARTMENT | ||||||||
| City: | WAMPSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131630608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153663005 | ||||||||
| FaxNumber: | 3153662599 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 NORTH COURT ST | ||||||||
| Address2: | MADISON COUNTY MENTAL HEALTH DEPARTMENT | ||||||||
| City: | WAMPSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131630608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153663005 | ||||||||
| FaxNumber: | 3153662599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2008 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 074576 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 074576 | 01 | NY | STATE LICENSE | OTHER |