Healthcare Provider Details

I. General information

NPI: 1285717157
Provider Name (Legal Business Name): MICHAEL JOSEPH HOERMANN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTER DR
RIVERHEAD NY
11901-3393
US

IV. Provider business mailing address

14 NORMAN DR
SHOREHAM NY
11786-1535
US

V. Phone/Fax

Practice location:
  • Phone: 631-852-1440
  • Fax: 631-852-1448
Mailing address:
  • Phone: 631-821-4829
  • Fax: 631-852-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number072347
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: