Healthcare Provider Details

I. General information

NPI: 1003242439
Provider Name (Legal Business Name): JUDITH PURDELL-HECKATHORN LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 BONIFACE DR
PINE BUSH NY
12566-7011
US

IV. Provider business mailing address

26 CRITTENDEN ST
WALLKILL NY
12589-3112
US

V. Phone/Fax

Practice location:
  • Phone: 845-863-7792
  • Fax:
Mailing address:
  • Phone: 845-863-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073465-1
License Number StateNY

VIII. Authorized Official

Name: JUDITH PURDELL-HECKATHORN
Title or Position: OWNER
Credential: LCSW
Phone: 845-863-7792