MEDICARE: MS. DARCY ELIAS HATHAWAY LCSW-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	072615	NY
2	1041C0700X	Clinical Social Worker	079182	NY

General Provider Information

NPI Number	:	1053584052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARCY ELIAS HATHAWAY LCSW-R

Provider Business Mailing Address
First Line	:	22 US OVAL
Second Line	:	SUITE 218
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5900
Country	:	US
Telephone Number	:	518-563-8293
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 US OVAL
Second Line	:	SUITE 218
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5900
Country	:	US
Telephone Number	:	518-563-8293
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	05/26/2014

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