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General NPI Number Information
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NPI Number | 1831342302
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Entity Type | Individual
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Provider Name | DIRK HENDRIK N. C. DE JONG LMSW
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 597 3RD AVE
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City | TROY
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State | NY
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Zip | 12182-2509
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Country | US
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Telephone | 518-233-0935
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Fax |
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Provider Business Mailing Address
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Address Line | 344 VLEY RD
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City | SCOTIA
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State | NY
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Zip | 12302-2830
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Country | US
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Telephone |
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 050686-1
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License Number State | NY
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