MEDICARE: ALICE DELACROIX MALTBIE L.M.H.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	000020-1	NY

General Provider Information

NPI Number	:	1003920752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE DELACROIX MALTBIE L.M.H.C.

Provider Business Mailing Address
First Line	:	518 HURON RD
Second Line	:
City	:	DELMAR
State	:	NY
Zip	:	12054-2606
Country	:	US
Telephone Number	:	518-463-6582
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 DELAWARE AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12209-1415
Country	:	US
Telephone Number	:	518-463-6582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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