| Mental Health & Addiction Services | |
|
130 Arizona Ave Ste 1500 Plattsburgh NY 12903-4908 | |
| (518) 565-4060 | |
| (518) 566-0168 |
| Full Name | Mental Health & Addiction Services |
|---|---|
| Speciality | Counselor |
| Location | 130 Arizona Ave Ste 1500, Plattsburgh, New York |
| Authorized Official Name and Position | Richelle Gregory (DIRECTOR OF COMMUNITY SERVICES) |
| Authorized Official Contact | 5185654060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Health & Addiction Services 130 Arizona Ave Ste 1500 Plattsburgh NY 12903-4908 Ph: (518) 565-4060 | Mental Health & Addiction Services 130 Arizona Ave Ste 1500 Plattsburgh NY 12903-4908 Ph: (518) 565-4060 |
| NPI Number | 1164465902 |
|---|---|
| Provider Enumeration Date | 06/13/2006 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 7618960600 |
|---|---|
| Medicare Enrollment ID | O20040406000510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164465902 | NPI | - | NPPES |
| 00672046 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 05727 (New York) | Secondary |
| 101YM0800X | Counselor - Mental Health | 685511 (New York) | Primary |
| Provider Name | Carmen A Chroback |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588626048 PECOS PAC ID: 7113911488 Enrollment ID: I20040409000538 |
| Provider Name | Bruce G Kokernot |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194827584 PECOS PAC ID: 3072670314 Enrollment ID: I20090331000581 |
| Provider Name | Steven S Keyser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255515078 PECOS PAC ID: 5698806065 Enrollment ID: I20100629000239 |
| Provider Name | Jessie Anne Notch-leblanc |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255443719 PECOS PAC ID: 9032388129 Enrollment ID: I20110805000576 |
| Provider Name | Kelly Hornby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043371370 PECOS PAC ID: 2961671607 Enrollment ID: I20110815000009 |
| Provider Name | Elisa Castillo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639280159 PECOS PAC ID: 7214107119 Enrollment ID: I20110901000496 |
| Provider Name | Jennifer A Facteau-rabideau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437406477 PECOS PAC ID: 1254586290 Enrollment ID: I20130225000202 |
| Provider Name | Darcy Elias Hathaway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053584052 PECOS PAC ID: 3779801964 Enrollment ID: I20150420001454 |
| Provider Name | Jodi R Hamel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962958553 PECOS PAC ID: 9931487683 Enrollment ID: I20161031002042 |
| Provider Name | Martin O Oviasogie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639695091 PECOS PAC ID: 8224378427 Enrollment ID: I20190326002249 |
| Provider Name | Jessica A Koenig |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083050967 PECOS PAC ID: 4486952017 Enrollment ID: I20210112001791 |
| Provider Name | Shilpa B Thayyullathil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356662258 PECOS PAC ID: 7113241191 Enrollment ID: I20210316000310 |
| Provider Name | Annette Fm Liem |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750814075 PECOS PAC ID: 8325385933 Enrollment ID: I20230126000173 |
| Provider Name | Amy L Belair |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295106441 PECOS PAC ID: 1557704863 Enrollment ID: I20240202003048 |
| Provider Name | Christine Lynn Stowe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699116962 PECOS PAC ID: 5395189021 Enrollment ID: I20240221000805 |
| Provider Name | Cassandra Hanley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477930659 PECOS PAC ID: 1052757226 Enrollment ID: I20240311000540 |
| Provider Name | Erica Lee Leonard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184144974 PECOS PAC ID: 2668810318 Enrollment ID: I20240401002638 |
| Provider Name | Dakota Flynn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053896704 PECOS PAC ID: 8820438310 Enrollment ID: I20240501001462 |
| Provider Name | Casey M Root-caron |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275703589 PECOS PAC ID: 3072953561 Enrollment ID: I20240501001612 |
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