MEDICARE: MR. ERIC HESS LCSW

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	R047183	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2195018	OTHER	NY	OXFORD PROVIDER ID
2	7735184	OTHER	NY	AETNA PROVIDER ID
3	NH526	OTHER	NY	EMPIRE BCBS ID
4	219933	OTHER	NY	MHN PROVIDER ID

General Provider Information

NPI Number	:	1619050358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC HESS LCSW

Provider Business Mailing Address
First Line	:	123 WAVERLY PL
Second Line	:	APT. 8C
City	:	NEW YORK
State	:	NY
Zip	:	10011-9147
Country	:	US
Telephone Number	:	917-705-6615
Fax Number	:	212-228-4247

Provider Business Practice Location Address
First Line	:	1115 BROADWAY STE 1128
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-3450
Country	:	US
Telephone Number	:	917-705-6615
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	10/13/2017

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