Provider Demographics
NPI:1508930454
Name:WHITE, ALBERT J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:J
Last Name:WHITE
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 1:11 HUGUENOT ST
Mailing Address - Street 2:# 3
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1720
Mailing Address - Country:US
Mailing Address - Phone:845-340-4074
Mailing Address - Fax:
Practice Address - Street 1:11 HUGUENOT ST
Practice Address - Street 2:# 3
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1720
Practice Address - Country:US
Practice Address - Phone:845-340-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073733-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN48X01Medicare ID - Type Unspecified