Basic Information
| Provider Information | |||||||||
| NPI: | 1841515178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RPC-MIDDLETOWN MENTAL HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 ASHLEY AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109401912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453268110 | ||||||||
| FaxNumber: | 8453268157 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 ASHLEY AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109401912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453268110 | ||||||||
| FaxNumber: | 8453268157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2010 | ||||||||
| LastUpdateDate: | 03/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | DECHER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE 3 | ||||||||
| AuthorizedOfficialTelephone: | 8453268110 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN, MSN,PNP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 400605-1 | NY | Y | Hospital Units | Psychiatric Unit |
No ID Information.