Provider Demographics
NPI:1164707527
Name:SQUILLACE, HELEN ANN
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:ANN
Last Name:SQUILLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 NEW SCOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-3622
Mailing Address - Country:US
Mailing Address - Phone:518-207-2066
Mailing Address - Fax:518-207-2069
Practice Address - Street 1:962 LUTHER RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-4015
Practice Address - Country:US
Practice Address - Phone:518-207-2066
Practice Address - Fax:518-207-2067
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01409145Medicaid