Healthcare Provider Details

I. General information

NPI: 1871644195
Provider Name (Legal Business Name): VIRGINIA THERESA KAISER PH.D, M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WOODLANDS DR
TUXEDO PARK NY
10987-4811
US

IV. Provider business mailing address

12 WOODLANDS DR
TUXEDO PARK NY
10987-4811
US

V. Phone/Fax

Practice location:
  • Phone: 845-753-5369
  • Fax: 845-753-5369
Mailing address:
  • Phone: 845-753-5369
  • Fax: 845-753-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR028968-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00175200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02261503
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: