Provider Demographics
NPI:1093802266
Name:CLINICAL SOCIAL WORK AND COUNSELING SERVICES OF THE FINGER LAKES
Entity type:Organization
Organization Name:CLINICAL SOCIAL WORK AND COUNSELING SERVICES OF THE FINGER LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MINOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSWR
Authorized Official - Phone:607-734-1447
Mailing Address - Street 1:963 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901
Mailing Address - Country:US
Mailing Address - Phone:607-734-1447
Mailing Address - Fax:607-737-6274
Practice Address - Street 1:963 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901
Practice Address - Country:US
Practice Address - Phone:607-734-1447
Practice Address - Fax:607-737-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53690AMedicare PIN