Youth of Lewis County

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Legal business name

YOUTH OF LEWIS COUNTY

Practice address

9502 State Route 12 Apt 2
Copenhagen, NY 13626-2952

Phone

(315) 816-6448

NPI assigned

Oct 8, 2024

Last updated

Oct 8, 2024By 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

Mr. Wyatt M Wagner

Title

Executive Director

Phone

(315) 816-6448

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1578382479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9502 STATE ROUTE 12 APT 2",
            "city": "COPENHAGEN",
            "state": "NY",
            "postal_code": "136262952",
            "telephone_number": "315-816-6448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9502 STATE ROUTE 12 APT 2",
            "city": "COPENHAGEN",
            "state": "NY",
            "postal_code": "136262952",
            "telephone_number": "315-816-6448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH OF LEWIS COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "WYATT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-816-6448",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laci Lynn Reilly, APRN
• Roger B Shambo, MD, LLC
• Norman Bruce Scott, D.O.
• Michelle Anne Shoen
• Rachel L Slate, LPN

• Peer Specialist in Copenhagen, NY
• Providers in Copenhagen, NY by specialty
• Peer Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.