Provider Demographics
NPI:1376966325
Name:BABCOCK, KENT (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 STILLWATER RD
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-5012
Mailing Address - Country:US
Mailing Address - Phone:845-657-7024
Mailing Address - Fax:
Practice Address - Street 1:166 STILLWATER RD
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5012
Practice Address - Country:US
Practice Address - Phone:845-807-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0604431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical