Southern Tier Nurse Practitioners in Psychiatry

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

SOUTHERN TIER NURSE PRACTITIONERS IN PSYCHIATRY

Practice address

141 Chautauqua Ave
Lakewood, NY 14750-1278

Phone

(716) 489-8850

NPI assigned

Apr 24, 2023

Last updated

Apr 24, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Clinton George, PMHDNPNPI 1821606237

Title

Provider

Phone

(716) 489-8850

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clinton T George, DNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Dunkirk, NY
  • NPI 1821606237
  Medicare reassignment Care Compare group NPD Authorized official
• Margaret Elizabeth Bird, PMHDNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Jamestown, NY
  • NPI 1659944171
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1225725880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 CHAUTAUQUA AVE",
            "city": "LAKEWOOD",
            "state": "NY",
            "postal_code": "147501278",
            "telephone_number": "716-489-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 CHAUTAUQUA AVE",
            "city": "LAKEWOOD",
            "state": "NY",
            "postal_code": "147501278",
            "telephone_number": "716-489-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN TIER NURSE PRACTITIONERS IN PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-22",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "716-489-8850",
        "authorized_official_credential": "PMHDNP"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Syed Ali Raza Shamsi, M.B.B.S.
• Mark E Simons, RPH
• David C Smith, DPM
• Alicia J Snow, PA-C
• Southern Tier Dentistry
• Step Forward Applied Behavior Analysis PLLC
• Eylessia Florintina Stilson
• Bonnelynn Marie Swanson, CCC-SLP
• Michael Philip Swanson, RPH
• Sharon Swanson

• Adult Mental Health Clinic/Center in Lakewood, NY
• Providers in Lakewood, NY by specialty
• Adult Mental Health Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.