Healthcare Provider Details

I. General information

NPI: 1114283942
Provider Name (Legal Business Name): LAURENCE PATRICK HEGARTY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 BROADWAY SIUTE 901
NEW YORK NY
10003-4703
US

IV. Provider business mailing address

853 BROADWAY SIUTE 901
NEW YORK NY
10003-4703
US

V. Phone/Fax

Practice location:
  • Phone: 212-619-7952
  • Fax:
Mailing address:
  • Phone: 212-619-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR054250-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: