Provider Demographics
NPI:1558700740
Name:HULSE, HEATHER L (LMSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:HULSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 N MAIN ST
Practice Address - Street 2:JOHN D. KELLY BEHAVIORAL HEALTH
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1069
Practice Address - Country:US
Practice Address - Phone:315-531-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059646-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker