Basic Information
| Provider Information | |||||||||
| NPI: | 1861032575 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHAUTAUQUA COUNTY MENTAL HYGIENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 ACADEMY ST RM 201 | ||||||||
| Address2: | |||||||||
| City: | MAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147571050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167534104 | ||||||||
| FaxNumber: | 7167534230 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 ACADEMY ST RM 201 | ||||||||
| Address2: | |||||||||
| City: | MAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147571050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167534104 | ||||||||
| FaxNumber: | 7167534230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2020 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | VON HOF | ||||||||
| AuthorizedOfficialFirstName: | ROCHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHILDREN'S SPOA | ||||||||
| AuthorizedOfficialTelephone: | 7166618857 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.