Healthcare Provider Details

I. General information

NPI: 1770648800
Provider Name (Legal Business Name): JUDITH R PURDELL-HECKATHORN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CRITTENDEN ST
WALLKILL NY
12589-3112
US

IV. Provider business mailing address

PO BOX 722
WALLKILL NY
12589-0722
US

V. Phone/Fax

Practice location:
  • Phone: 845-863-7792
  • Fax:
Mailing address:
  • Phone: 845-863-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073465-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: