Provider Demographics
NPI:1184217473
Name:RACE, HANNAH (MSED)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:RACE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HILL ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1247
Mailing Address - Country:US
Mailing Address - Phone:315-681-8248
Mailing Address - Fax:
Practice Address - Street 1:18 HILL ST APT 1D
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1247
Practice Address - Country:US
Practice Address - Phone:315-681-8248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106880-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health