Healthcare Provider Details

I. General information

NPI: 1821337270
Provider Name (Legal Business Name): JONATHAN HUBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 FRANKLIN ST 2ND FLOOR
SCHENECTADY NY
12305-2011
US

IV. Provider business mailing address

530 FRANKLIN ST 2ND FLOOR
SCHENECTADY NY
12305-2011
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number72 088650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: