Healthcare Provider Details

I. General information

NPI: 1922161413
Provider Name (Legal Business Name): CHARLENE ANN HRACHIAN MSW, LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 MADISON AVE
ALBANY NY
12208-3392
US

IV. Provider business mailing address

40 WHEELER DR
CLIFTON PARK NY
12065-1814
US

V. Phone/Fax

Practice location:
  • Phone: 518-427-5004
  • Fax:
Mailing address:
  • Phone: 518-383-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR030137-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: