Provider Demographics
NPI:1528457454
Name:KENNETH C PRICE LCSW PLLC
Entity type:Organization
Organization Name:KENNETH C PRICE LCSW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-405-7773
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:FELTS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13638-0189
Mailing Address - Country:US
Mailing Address - Phone:315-405-7773
Mailing Address - Fax:
Practice Address - Street 1:32133 NYS ROUTE 3
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9524
Practice Address - Country:US
Practice Address - Phone:315-405-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0770301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty