Healthcare Provider Details

I. General information

NPI: 1659700417
Provider Name (Legal Business Name): PATRICIA HUFNAGLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 OAK TREE RD
EDISON NJ
08820-2012
US

IV. Provider business mailing address

2048 OAK TREE RD
EDISON NJ
08820-2012
US

V. Phone/Fax

Practice location:
  • Phone: 732-906-2662
  • Fax: 732-906-2779
Mailing address:
  • Phone: 732-906-2662
  • Fax: 732-906-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04519900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4484002
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: