| Crystal Waters Licensed Clinical Social Work, Pllc | |
|
83 W Pulteney St Corning NY 14830-2213 | |
| (607) 654-9872 | |
| (607) 973-2727 |
| Full Name | Crystal Waters Licensed Clinical Social Work, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 83 W Pulteney St, Corning, New York |
| Authorized Official Name and Position | Janet L Fabian (OWNER) |
| Authorized Official Contact | 6076549872 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Waters Licensed Clinical Social Work, Pllc 62 South St Addison NY 14801-1319 Ph: (607) 654-9872 | Crystal Waters Licensed Clinical Social Work, Pllc 83 W Pulteney St Corning NY 14830-2213 Ph: (607) 654-9872 |
| NPI Number | 1821599788 |
|---|---|
| Provider Enumeration Date | 02/26/2018 |
| Last Update Date | 02/26/2018 |
| Medicare PECOS PAC ID | 1658628151 |
|---|---|
| Medicare Enrollment ID | O20180716000028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821599788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 080623 (New York) | Primary |
| Provider Name | Janet L Fabian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174766042 PECOS PAC ID: 2365665460 Enrollment ID: I20140519000039 |
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