Provider Demographics
NPI:1124372263
Name:HUBENY, HEATHER KAYSON (LCSWR)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KAYSON
Last Name:HUBENY
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WASHINGTON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5305
Mailing Address - Country:US
Mailing Address - Phone:607-205-8528
Mailing Address - Fax:607-348-1742
Practice Address - Street 1:56 WASHINGTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5305
Practice Address - Country:US
Practice Address - Phone:607-205-8528
Practice Address - Fax:607-348-1742
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0838331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical