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General NPI Number Information
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NPI Number | 1346495710
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Entity Type | Organization
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Legal Business Name | HOLLOW HILLS LICENSED CLINICAL SOCIAL WORK P.C.
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Dates
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Enumeration Date | 11/26/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 31 MELROSE RD
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City | DIX HILLS
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State | NY
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Zip | 11746-5610
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Country | US
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Telephone | 631-425-1168
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Fax | 631-673-0313
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Provider Business Mailing Address
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Address Line | 31 MELROSE RD
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City | DIX HILLS
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State | NY
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Zip | 11746-5610
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Country | US
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Telephone | 631-425-1168
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Fax | 631-673-0313
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM PATRICK FENTY
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Credential | LCSW
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Telephone | 631-425-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | R054186-1
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License Number State | NY
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