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Lewis County
New York
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Children with Special Needs
Children with Special Needs Programs Referral
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General Information
Staff Directory
Director
Ashley Waite, RN, BSN, MPH
(315) 376-5453
ashleywaite@lewiscounty.ny.gov
Location
7785 N State St
Suite 2
Lowville,
NY
13367
Get Directions
Hours
M-F
8:30 AM - 4:30 PM
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Children with Special Needs Programs Referral
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Children with Special Needs Programs Referral
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To view more details about our programs, please
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Please choose one of the following programs:
Child Find
Early Intervention
Preschool
PHCP
CYSHCN
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Today's Date:
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Child's Name:
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Date Of Birth:
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Sex:
Male
Female
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Person Making Referral:
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Phone #:
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Parent/Guardian:
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Phone #:
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Mailing Address:
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City/Town:
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Zip Code:
School District:
Harrisville Central School
Beaver River Central School
Lowville Academy Central School
Copenhagen Central School
South Lewis Central School
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Language Used At Home:
Child's Race:
Child's Ethnicity:
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Primary Health Care Provider’s Name:
Medicaid Eligible?
Yes
No
Medicaid Number:
Insurance Co.
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REASON FOR REFERRAL: (ICD-9 Code if applicable)
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