Provider Demographics
NPI:1639700438
Name:BANG, NATASHA CONOVER (LMSW)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:CONOVER
Last Name:BANG
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 1:108 GLEN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9002
Mailing Address - Country:US
Mailing Address - Phone:518-655-0070
Mailing Address - Fax:
Practice Address - Street 1:260 WASHINGTON AVENUE EXT STE 101
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-6326
Practice Address - Country:US
Practice Address - Phone:518-218-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0669691041C0700X
NY0669691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical