Orange County Dept of Menttal Health

Primary specialty

Social WorkerTaxonomy code 104100000X

License

070519 Issued in NY

Legal business name

ORANGE COUNTY DEPT OF MENTTAL HEALTH

Practice address

146 Pike St
Port Jervis, NY 12771-1808

Phone

(845) 858-1456

Fax

(845) 858-1459

NPI assigned

May 10, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Thomas R Bolzan, MS

Title

Director of Clinical Services

Phone

(845) 291-2608

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1273449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273449600000",
    "number": "1740508142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 PIKE ST",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127711808",
            "telephone_number": "845-858-1456",
            "fax_number": "845-858-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 PIKE ST",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127711808",
            "telephone_number": "845-858-1456",
            "fax_number": "845-858-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE COUNTY DEPT OF MENTTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-10",
        "last_updated": "2010-05-10",
        "status": "A",
        "authorized_official_last_name": "BOLZAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "845-291-2608",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "NY",
            "license": "070519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "070519",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Port Jervis, NY
• Providers in Port Jervis, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2010; 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.