Healthcare Provider Details

I. General information

NPI: 1790191443
Provider Name (Legal Business Name): HENA JABEEN HODA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6889 STATE ROUTE 434
APALACHIN NY
13732-3503
US

IV. Provider business mailing address

6889 STATE ROUTE 434
APALACHIN NY
13732-3503
US

V. Phone/Fax

Practice location:
  • Phone: 607-625-4843
  • Fax: 607-625-4846
Mailing address:
  • Phone: 607-625-4843
  • Fax: 607-625-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088483
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number72 P93395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: