MEDICARE: MS. RENEE S HACK MSW

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	1041C0700X	Clinical Social Worker	PR011044-1	NY
2	1041C0700X	Clinical Social Worker	PR011004-1	NY

General Provider Information

NPI Number	:	1194888636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE S HACK MSW

Provider Business Mailing Address
First Line	:	5 STONEHEDGE AVE
Second Line	:
City	:	NEW PALTZ
State	:	NY
Zip	:	12561-3127
Country	:	US
Telephone Number	:	845-255-7556
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 STONEHEDGE AVE
Second Line	:
City	:	NEW PALTZ
State	:	NY
Zip	:	12561-3127
Country	:	US
Telephone Number	:	845-255-7556
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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