Basic Information
| Provider Information | |||||||||
| NPI: | 1851767339 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INSTITUTE FOR FAMILY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 PUTNAM DR | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105125653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148442387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 FAMILY PRACTICE DR | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124016449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453382562 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2015 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | LCSW-R SUPERVISING SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 8452552930 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW-R | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.