| Madison County Mental Health Department Outpatient Clinic | |
|
138 North Court Street Wampsville NY 13163-0608 | |
| (315) 366-2327 | |
| (315) 366-2599 |
| Full Name | Madison County Mental Health Department Outpatient Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 138 North Court Street, Wampsville, New York |
| Authorized Official Name and Position | Teisha M Cook (DIRECTOR) |
| Authorized Official Contact | 3153662327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison County Mental Health Department Outpatient Clinic 138 North Court Street Wampsville NY 13163-0608 Ph: (315) 366-2327 | Madison County Mental Health Department Outpatient Clinic 138 North Court Street Wampsville NY 13163-0608 Ph: (315) 366-2327 |
| NPI Number | 1689780546 |
|---|---|
| Provider Enumeration Date | 08/22/2006 |
| Last Update Date | 12/06/2019 |
| Medicare PECOS PAC ID | 2365335957 |
|---|---|
| Medicare Enrollment ID | O20040206000289 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689780546 | NPI | - | NPPES |
| 00569860 | Medicaid | NY | |
| 03004400 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 6873100A (New York) | Primary |
| Provider Name | Teisha M Cook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447443437 PECOS PAC ID: 4981793429 Enrollment ID: I20071205000459 |
| Provider Name | Denise M Calcagnino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518990811 PECOS PAC ID: 7113058520 Enrollment ID: I20100629000644 |
| Provider Name | Susan M Chlebowski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508878521 PECOS PAC ID: 0547448128 Enrollment ID: I20110630000100 |
| Provider Name | Erika L Demarche |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902093677 PECOS PAC ID: 1557581527 Enrollment ID: I20140926000186 |
| Provider Name | Kelly M Dorman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902234917 PECOS PAC ID: 4284854126 Enrollment ID: I20140929000146 |
| Provider Name | Theresa M Blatchford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437411048 PECOS PAC ID: 9537455142 Enrollment ID: I20160908000769 |
| Provider Name | Kathryn E Hopkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922495282 PECOS PAC ID: 8921380429 Enrollment ID: I20170118000397 |
| Provider Name | Edward S Zimmerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255865341 PECOS PAC ID: 8921378654 Enrollment ID: I20170727003186 |
| Provider Name | Allyson J Kemp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063948776 PECOS PAC ID: 3870866734 Enrollment ID: I20170829002255 |
| Provider Name | Rene Hunter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578873329 PECOS PAC ID: 2961752118 Enrollment ID: I20180910000300 |
| Provider Name | Lisa A Lemura |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194121442 PECOS PAC ID: 1254677842 Enrollment ID: I20190118001817 |
| Provider Name | Jennifer A Ashley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992175681 PECOS PAC ID: 5890035232 Enrollment ID: I20190320002864 |
| Provider Name | Norma T Dipietro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912556887 PECOS PAC ID: 4082946405 Enrollment ID: I20191104001629 |
| Provider Name | Meghan T Conway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811404791 PECOS PAC ID: 9335556786 Enrollment ID: I20210331000739 |
| Provider Name | Erin J Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487081014 PECOS PAC ID: 9234536475 Enrollment ID: I20210930001370 |
| Provider Name | Stephanie P Kitchen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497411383 PECOS PAC ID: 3971985631 Enrollment ID: I20220728000750 |
| Provider Name | Mallory R Kleps |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871157065 PECOS PAC ID: 9234583949 Enrollment ID: I20230929000338 |
| Provider Name | Shannyn Ryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790341485 PECOS PAC ID: 1557715935 Enrollment ID: I20231004001225 |
| Provider Name | Taylor N Jayson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730869652 PECOS PAC ID: 6204288533 Enrollment ID: I20240123000096 |
County Of Madison Mental Health Department Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 138 N. Court Street, Wampsville, NY 13163 Phone: 315-366-2327 |