Healthcare Provider Details

I. General information

NPI: 1164521795
Provider Name (Legal Business Name): ALLAN W. HUMPHREY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

IV. Provider business mailing address

17 HUDSON DR
HYDE PARK NY
12538-2014
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-3570
  • Fax: 845-486-3599
Mailing address:
  • Phone: 845-229-8774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPRO14301-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: