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General NPI Number Information
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NPI Number | 1558418624
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Entity Type | Individual
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Provider Name | PAUL JOHN HOUTKOOPER LCSW-R
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 5 ACADEMY ST
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City | NEW PALTZ
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State | NY
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Zip | 12561-1702
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Country | US
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Telephone | 917-913-2599
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Fax | 212-316-7021
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Provider Business Mailing Address
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Address Line | 409 SWARTEKILL RD
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City | HIGHLAND
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State | NY
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Zip | 12528-2923
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Country | US
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Telephone | 917-913-2599
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Fax | 212-316-7021
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | R077896-1
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License Number State | NY
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