Provider Demographics
NPI:1164585824
Name:HAKAM, JUDITH (ACSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:HAKAM
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 MAIN ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1128
Mailing Address - Country:US
Mailing Address - Phone:845-255-4166
Mailing Address - Fax:845-255-4166
Practice Address - Street 1:134 MAIN ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1128
Practice Address - Country:US
Practice Address - Phone:845-255-4166
Practice Address - Fax:845-255-4166
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR030827-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742667Medicaid
NY900457OtherMVP
NYN40211OtherEMPIRE BLUE CROSS AND BLU
NY123048OtherVALUE OPTIONS
NY4016641OtherCHAMPUS
NY7400214OtherGHI
NY238794OtherMHN
NY344939OtherOXFORD
NY344939OtherWELLCARE
NY4016641OtherCHAMPUS