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General NPI Number Information
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NPI Number | 1134578446
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Entity Type | Organization
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Legal Business Name | MID-HUDSON SERVICES LCSW P.C.
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 12 WALNUT ST
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City | STONY POINT
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State | NY
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Zip | 10980-1327
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Country | US
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Telephone | 914-557-4310
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Fax | 845-947-1802
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Provider Business Mailing Address
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Address Line | 76 W RAILROAD AVE
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City | GARNERVILLE
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State | NY
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Zip | 10923-1218
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Country | US
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Telephone | 914-557-4310
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Fax | 845-947-1802
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. ALAN FUENTES
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Credential | LCSW
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Telephone | 914-557-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | R054103-1
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License Number State | NY
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