Basic Information
| Provider Information | |||||||||
| NPI: | 1164521795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMPHREY | ||||||||
| FirstName: | ALLAN | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 HUDSON DR | ||||||||
| Address2: | |||||||||
| City: | HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125382014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452298774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 NORTH RD | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126011328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454863570 | ||||||||
| FaxNumber: | 8454863599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | PRO14301-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.