Provider Demographics
NPI:1255470126
Name:HARTIGAN, JOHN JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:HARTIGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 TROTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-3013
Mailing Address - Country:US
Mailing Address - Phone:518-859-7843
Mailing Address - Fax:
Practice Address - Street 1:40 NORTH MAIN AVENUE
Practice Address - Street 2:COUNSELING FOR LAITY-ROMAN CATHOLIC DIOCESE PASTORAL CT
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-453-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043743-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02133860Medicaid
NYDD0728Medicare ID - Type Unspecified
NYDD0728Medicare UPIN