Healthcare Provider Details

I. General information

NPI: 1447589163
Provider Name (Legal Business Name): ANDREA HOPKINS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 ROANOKE AVE
RIVERHEAD NY
11901-2098
US

IV. Provider business mailing address

1380 ROANOKE AVE
RIVERHEAD NY
11901-2098
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-4418
  • Fax: 631-369-4421
Mailing address:
  • Phone: 631-369-4418
  • Fax: 631-369-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number72068852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: