Healthcare Provider Details

I. General information

NPI: 1134752520
Provider Name (Legal Business Name): DANIEL HUTNICK LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL CABRERA LMSW

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GRAND ST FL 4
NEW YORK NY
10002-4629
US

IV. Provider business mailing address

298 S AMENIA RD
AMENIA NY
12501-5857
US

V. Phone/Fax

Practice location:
  • Phone: 212-475-4148
  • Fax:
Mailing address:
  • Phone: 347-421-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number089491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: