Provider Demographics
NPI:1558418624
Name:HOUTKOOPER, PAUL JOHN (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOHN
Last Name:HOUTKOOPER
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SWARTEKILL RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2923
Mailing Address - Country:US
Mailing Address - Phone:917-913-2599
Mailing Address - Fax:212-316-7021
Practice Address - Street 1:5 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1702
Practice Address - Country:US
Practice Address - Phone:917-913-2599
Practice Address - Fax:212-316-7021
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR077896-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical