Healthcare Provider Details

I. General information

NPI: 1508975244
Provider Name (Legal Business Name): C THADDEA COMPAIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 MAIN ST
SAUGERTIES NY
12477-1355
US

IV. Provider business mailing address

PO BOX 518
SAUGERTIES NY
12477-0518
US

V. Phone/Fax

Practice location:
  • Phone: 845-389-0445
  • Fax:
Mailing address:
  • Phone: 845-389-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR024245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: