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Corporate Practice Membership

Corporate Practice Membership Form

ADDITIONAL OFFICES: YesNo

The MHAW does not share the names of its members with any other organization.

Group Practice Membership (includes website listing) $750 Annual Fee
Criterion for Listing on MHAW Website

To be listed as a Group Practice in the Resource Section of our website and to be included in our telephone Information and Referral database, you must meet the following criterion and submit the required documents:

  • Be licensed in NYS and in practice a minimum of two years
  • Provide MHAW with a copy of your NYS Certificate of licensure

By meeting the above, your name, address and telephone number will appear on our website database under your profession and areas of practice, and be included in our telephone Information and Referral database.


Practice Information: (Please provide MHAW with any brochures, material or additional information regarding your services.)

PROFESSION*: PsychiatristSocial WorkerMHCPsychologistNurse PractitionerCASACOther
POPULATIONS(S) SERVED*: InfantsChildrenAdolescentsAdultsElderly, Age Range:
MODALITY*: IndividualCouplesFamilyGroupHomebound Services
THERAPEUTIC APPROACH:
EXPERTISE W/ SPECIFIC POPULATIONS:
FREE CONSULTATION: YesNo
EVALUATIONS: YesNo If yes, please list type:



Insurance Information:

SLIDING SCALE: YesNo
MEDICARE: YesNo
MEDICAID: YesNo
ACCEPTED INSURANCE:


Check Areas of Practice and Expertise (Limited to Six Categories for website listing)

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