Healthcare Provider Details

I. General information

NPI: 1861704983
Provider Name (Legal Business Name): DENISE CAROLE HANLON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 09/07/2022
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KUKUK LN
KINGSTON NY
12401-6943
US

IV. Provider business mailing address

70 KUKUK LN
KINGSTON NY
12401-6943
US

V. Phone/Fax

Practice location:
  • Phone: 845-336-2616
  • Fax:
Mailing address:
  • Phone: 845-336-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081486
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number607509951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: