Healthcare Provider Details

I. General information

NPI: 1679207492
Provider Name (Legal Business Name): PATRICE HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2022
Last Update Date: 07/16/2022
Certification Date: 07/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD COUNTRY RD STE 316
GARDEN CITY NY
11530-1944
US

IV. Provider business mailing address

500 OLD COUNTRY RD STE 316
GARDEN CITY NY
11530-1944
US

V. Phone/Fax

Practice location:
  • Phone: 516-279-5333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP115809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: