Provider Demographics
NPI:1568763308
Name:HECHT, CHERYL LYNN (LCSW, MPH, CPGC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:HECHT
Suffix:
Gender:F
Credentials:LCSW, MPH, CPGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 JOHNSON AVE
Mailing Address - Street 2:STE 12
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2686
Mailing Address - Country:US
Mailing Address - Phone:631-428-3799
Mailing Address - Fax:631-750-9457
Practice Address - Street 1:606 JOHNSON AVE
Practice Address - Street 2:STE 12
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2686
Practice Address - Country:US
Practice Address - Phone:631-428-3799
Practice Address - Fax:631-750-9457
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082218-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400122459Medicare PIN