Provider Demographics
NPI:1093084824
Name:HISCOCK, CHRISTINE PATRICIA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:PATRICIA
Last Name:HISCOCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:PATRICIA
Other - Last Name:HISCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:10 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1501
Mailing Address - Country:US
Mailing Address - Phone:516-644-4020
Mailing Address - Fax:516-644-4129
Practice Address - Street 1:10 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1501
Practice Address - Country:US
Practice Address - Phone:516-644-4020
Practice Address - Fax:516-644-4129
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist