Provider Demographics
NPI:1619050358
Name:HESS, ERIC (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:HESS
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 1:123 WAVERLY PL
Mailing Address - Street 2:APT. 8C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9147
Mailing Address - Country:US
Mailing Address - Phone:917-705-6615
Mailing Address - Fax:212-228-4247
Practice Address - Street 1:1115 BROADWAY STE 1128
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3450
Practice Address - Country:US
Practice Address - Phone:917-705-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0471831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2195018OtherOXFORD PROVIDER ID
NY7735184OtherAETNA PROVIDER ID
NYNH526OtherEMPIRE BCBS ID
NY219933OtherMHN PROVIDER ID
NY219933OtherMHN PROVIDER ID