Healthcare Provider Details

I. General information

NPI: 1023668431
Provider Name (Legal Business Name): THOMAS EDWARD HULIHAN LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 FRANKLIN ST
SCHENECTADY NY
12305-2008
US

IV. Provider business mailing address

1320 6TH AVE
WATERVLIET NY
12189-3212
US

V. Phone/Fax

Practice location:
  • Phone: 518-381-8911
  • Fax: 518-377-4292
Mailing address:
  • Phone: 518-590-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR030138-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: