Healthcare Provider Details

I. General information

NPI: 1649322959
Provider Name (Legal Business Name): PAULA ECKARDT LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 3RD ST
RENSSELAER NY
12144-1539
US

IV. Provider business mailing address

1641 3RD ST
RENSSELAER NY
12144-1539
US

V. Phone/Fax

Practice location:
  • Phone: 518-463-8869
  • Fax: 518-463-8733
Mailing address:
  • Phone: 518-463-8869
  • Fax: 518-463-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR041057-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: