Healthcare Provider Details

I. General information

NPI: 1346500345
Provider Name (Legal Business Name): WAHIENHAWI HALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 STATE ROUTE 37
HOGANSBURG NY
13655
US

IV. Provider business mailing address

404 STATE ROUTE 37
HOGANSBURG NY
13655
US

V. Phone/Fax

Practice location:
  • Phone: 518-358-3141
  • Fax: 518-358-9175
Mailing address:
  • Phone: 518-358-3141
  • Fax: 518-358-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088275-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: