Healthcare Provider Details

I. General information

NPI: 1104827260
Provider Name (Legal Business Name): MARIE HEGEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8-12 DIETZ ST STE 201
ONEONTA NY
13820-1849
US

IV. Provider business mailing address

8-12 DIETZ ST STE 201
ONEONTA NY
13820-1849
US

V. Phone/Fax

Practice location:
  • Phone: 607-432-9039
  • Fax: 607-432-7029
Mailing address:
  • Phone: 607-432-9039
  • Fax: 607-432-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR051270 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: