Healthcare Provider Details

I. General information

NPI: 1639512577
Provider Name (Legal Business Name): MICHAEL JOSEPH HANRAHAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PARKWOOD BLVD
POUGHKEEPSIE NY
12603-4114
US

IV. Provider business mailing address

74 PARKWOOD BLVD
POUGHKEEPSIE NY
12603-4114
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-5490
  • Fax:
Mailing address:
  • Phone: 845-471-5490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number73 080456
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73-080456
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: