| Central Adirondack Counseling Lcsw Pllc | |
|
333 Glen St Ste 100 Glens Falls NY 12801-3578 | |
| (518) 307-9292 | |
| (518) 615-5801 |
| Full Name | Central Adirondack Counseling Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 333 Glen St Ste 100, Glens Falls, New York |
| Authorized Official Name and Position | Tacey A Shannon (LCSWR) |
| Authorized Official Contact | 5183079292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Adirondack Counseling Lcsw Pllc 60 Meldon Cir Queensbury NY 12804-5857 Ph: (518) 307-9292 | Central Adirondack Counseling Lcsw Pllc 333 Glen St Ste 100 Glens Falls NY 12801-3578 Ph: (518) 307-9292 |
| NPI Number | 1255917043 |
|---|---|
| Provider Enumeration Date | 03/22/2021 |
| Last Update Date | 03/22/2021 |
| Certification Date | 03/22/2021 |
| Medicare PECOS PAC ID | 5294124186 |
|---|---|
| Medicare Enrollment ID | O20211115002463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255917043 | NPI | - | NPPES |
| 1992101505 | Other | NY | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tacey A Shannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992101505 PECOS PAC ID: 0042567166 Enrollment ID: I20180720001070 |
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