Basic Information
| Provider Information | |||||||||
| NPI: | 1760835748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA HUDSON VALLEY HCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | BUILDING 28 | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884825 | ||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | BUILDING 28 | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2016 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 9147374400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2990 | CT | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.