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General NPI Number Information
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NPI Number | 1134674385
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Entity Type | Organization
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Legal Business Name | HOPE FOR HEALING LICENSED CLINICAL SOCIAL WORK PC
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 421 NEW KARNER RD SUITE 2
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City | ALBANY
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State | NY
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Zip | 12205-3861
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Country | US
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Telephone | 518-441-5660
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Fax | 518-689-6869
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Provider Business Mailing Address
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Address Line | 104A HECKELER DR
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City | GLENVILLE
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State | NY
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Zip | 12302-5313
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Country | US
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Telephone | 518-384-1517
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Fax | 518-384-1358
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Authorized Official
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Title or Position | BILLING/CREDENTIALING MANAGER
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Name | MARY-JANE QUICK
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Credential |
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Telephone | 518-384-1517
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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 | 082388-1
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License Number State | NY
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