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General NPI Number Information
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NPI Number | 1003242439
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Entity Type | Organization
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Legal Business Name | JUDITH PURDELL-HECKATHORN LCSW PLLC
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 59 BONIFACE DR
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City | PINE BUSH
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State | NY
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Zip | 12566-7011
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Country | US
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Telephone | 845-863-7792
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Fax |
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Provider Business Mailing Address
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Address Line | 26 CRITTENDEN ST
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City | WALLKILL
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State | NY
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Zip | 12589-3112
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Country | US
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Telephone | 845-863-7792
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUDITH PURDELL-HECKATHORN
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Credential | LCSW
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Telephone | 845-863-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 073465-1
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License Number State | NY
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