Provider Demographics
NPI:1346495710
Name:HOLLOW HILLS LICENSED CLINICAL SOCIAL WORK P.C.
Entity Type:Organization
Organization Name:HOLLOW HILLS LICENSED CLINICAL SOCIAL WORK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FENTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-425-1168
Mailing Address - Street 1:31 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5610
Mailing Address - Country:US
Mailing Address - Phone:631-425-1168
Mailing Address - Fax:631-673-0313
Practice Address - Street 1:31 MELROSE RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5610
Practice Address - Country:US
Practice Address - Phone:631-425-1168
Practice Address - Fax:631-673-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR054186-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty