Healthcare Provider Details

I. General information

NPI: 1366567992
Provider Name (Legal Business Name): F. RANDOLPH HULBERT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FREDERICK RANDOLPH HULBERT LCSW

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 SPRING ST
JAMESTOWN NY
14701-5323
US

IV. Provider business mailing address

14 MARI LN
FREWSBURG NY
14738-9524
US

V. Phone/Fax

Practice location:
  • Phone: 716-484-9840
  • Fax: 716-664-5186
Mailing address:
  • Phone: 716-569-2077
  • Fax: 716-664-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR035823
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: