Provider Demographics
NPI:1104827260
Name:HEGEMAN, MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:HEGEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8-12 DIETZ ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1849
Mailing Address - Country:US
Mailing Address - Phone:607-432-9039
Mailing Address - Fax:607-432-7029
Practice Address - Street 1:8-12 DIETZ ST
Practice Address - Street 2:STE 201
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1849
Practice Address - Country:US
Practice Address - Phone:607-432-9039
Practice Address - Fax:607-432-7029
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051270 1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY618044OtherMVP
NY326079OtherMHN
NY7335342002OtherVALUE OPTIONS
NY618044OtherMVP