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General NPI Number Information
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NPI Number | 1811054786
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Entity Type | Organization
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Legal Business Name | HEAWON HAKE INC.
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3771 NESCONSET HWY SUITE 208A
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1163
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Country | US
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Telephone | 631-751-1300
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Fax | 631-751-1300
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Provider Business Mailing Address
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Address Line | 3771 NESCONSET HWY SUITE 208A
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1163
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Country | US
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Telephone | 631-751-1300
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Fax | 631-751-1300
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HEAWON HAKE
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Credential | LCSW
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Telephone | 631-751-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 038650
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License Number State | NY
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