Provider Demographics
NPI:1134674385
Name:HOPE FOR HEALING LICENSED CLINICAL SOCIAL WORK PC
Entity Type:Organization
Organization Name:HOPE FOR HEALING LICENSED CLINICAL SOCIAL WORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY-JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-384-1517
Mailing Address - Street 1:104A HECKELER DR
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5313
Mailing Address - Country:US
Mailing Address - Phone:518-384-1517
Mailing Address - Fax:518-384-1358
Practice Address - Street 1:421 NEW KARNER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3861
Practice Address - Country:US
Practice Address - Phone:518-441-5660
Practice Address - Fax:518-689-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082388-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty