Healthcare Provider Details

I. General information

NPI: 1861478786
Provider Name (Legal Business Name): KIMBERLY A HOSTIG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 FRANKLIN ST
SCHENECTADY NY
12305
US

IV. Provider business mailing address

8 STANLEY CIR
LATHAM NY
12110-2606
US

V. Phone/Fax

Practice location:
  • Phone: 518-374-3403
  • Fax:
Mailing address:
  • Phone: 518-222-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number067230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: