| |
107 Hawthorne Dr Camillus NY 13031-1407 | |
(315) 492-4899 | |
(315) 883-8305 |
Full Name | |
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Speciality | Counselor |
Location | 107 Hawthorne Dr, Camillus, New York |
Authorized Official Name and Position | Kathryn R Oconnell (CEO) |
Authorized Official Contact | 1315492489 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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107 Hawthorne Dr Camillus NY 13031-1407 Ph: (315) 492-4899 | 107 Hawthorne Dr Camillus NY 13031-1407 Ph: (315) 492-4899 |
NPI Number | 1023871324 |
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Provider Enumeration Date | 01/31/2024 |
Last Update Date | 07/18/2024 |
Certification Date | 07/17/2024 |
Medicare PECOS PAC ID | 4688110307 |
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Medicare Enrollment ID | O20240718001158 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023871324 | NPI | - | NPPES |
002419-01 | Other | NY | INSURANCE COMPANIES |
02046257 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Kathryn Ruth O'connell |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1467596296 PECOS PAC ID: 5597201210 Enrollment ID: I20240718001549 |
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