| Community Clinic Of Jefferson County | |
|
211 Jb Wise Pl Watertown NY 13601-2507 | |
| (315) 782-7445 | |
| (315) 779-1184 |
| Full Name | Community Clinic Of Jefferson County |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 211 Jb Wise Pl, Watertown, New York |
| Authorized Official Name and Position | Michelle L Monnat (PRESIDENT AND CEO) |
| Authorized Official Contact | 3157887430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Clinic Of Jefferson County Po Box 6550 1704 State Street Watertown NY 13601-6550 Ph: (315) 788-7430 | Community Clinic Of Jefferson County 211 Jb Wise Pl Watertown NY 13601-2507 Ph: (315) 782-7445 |
| NPI Number | 1538455696 |
|---|---|
| Provider Enumeration Date | 06/27/2011 |
| Last Update Date | 07/08/2024 |
| Certification Date | 07/08/2024 |
| Medicare PECOS PAC ID | 6002088416 |
|---|---|
| Medicare Enrollment ID | O20111007000063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538455696 | NPI | - | NPPES |
| 9298014A | Other | NY | NEW YORK STATE OFFICE OF MENTAL HEALTH/OPERATING CERTIFICATE |
| 3372621 | Medicaid | NY |
| Provider Name | Steven M Fogelman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821137712 PECOS PAC ID: 9133174782 Enrollment ID: I20050316000408 |
| Provider Name | Anne E U Bates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225136047 PECOS PAC ID: 2062515463 Enrollment ID: I20070305000487 |
| Provider Name | Ashok Goyal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760507677 PECOS PAC ID: 5496887473 Enrollment ID: I20100712000247 |
| Provider Name | Lawrence J Palinski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306986823 PECOS PAC ID: 5597929729 Enrollment ID: I20120619000411 |
| Provider Name | Steven L Adams |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013958347 PECOS PAC ID: 0244123842 Enrollment ID: I20120821000333 |
| Provider Name | Linda L Macqueen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831441344 PECOS PAC ID: 8022257062 Enrollment ID: I20130624000086 |
| Provider Name | Patricia H Leone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457789984 PECOS PAC ID: 7012139405 Enrollment ID: I20141120000398 |
| Provider Name | Anne Jeannette Nans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558582411 PECOS PAC ID: 1456592666 Enrollment ID: I20150313000816 |
| Provider Name | Amanda L Hance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023546843 PECOS PAC ID: 1658643291 Enrollment ID: I20170817000492 |
| Provider Name | Scott F Ulberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700297686 PECOS PAC ID: 4385990787 Enrollment ID: I20180627001006 |
| Provider Name | Kourtney K Darrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417515552 PECOS PAC ID: 3274869508 Enrollment ID: I20190724003714 |
| Provider Name | Austen J Labarge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750832739 PECOS PAC ID: 1153757588 Enrollment ID: I20200204000844 |
| Provider Name | Zachary Ryan Lynch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659920890 PECOS PAC ID: 9335569433 Enrollment ID: I20201012000401 |
| Provider Name | Raymond Edwin Suarez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255538245 PECOS PAC ID: 9436334786 Enrollment ID: I20210312000485 |
| Provider Name | Shawna Leanne Stone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154708121 PECOS PAC ID: 5799179677 Enrollment ID: I20220221000094 |
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