=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891349114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIANNA LYNNE HINE LCAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2019
-----------------------------------------------------
Last Update Date | 07/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4988 STATE HIGHWAY 30 CHILDREN'S MENTAL HEALTH OP CLINIC
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-7520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-841-3747
-----------------------------------------------------
Fax | 518-841-3744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4988 STATE HIGHWAY 30 CHILDREN MENTAL HEALTH OP CLINIC
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-7520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-841-3747
-----------------------------------------------------
Fax | 518-841-3744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 221700000X
-----------------------------------------------------
Taxonomy Name | Art Therapist
-----------------------------------------------------
License Number | 002207
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------