Provider Demographics
NPI:1710331418
Name:HALL, HARLAN R JR (LMSW)
Entity Type:Individual
Prefix:
First Name:HARLAN
Middle Name:R
Last Name:HALL
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MOCCASIN BND
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1021
Mailing Address - Country:US
Mailing Address - Phone:518-899-6707
Mailing Address - Fax:
Practice Address - Street 1:19 MOCCASIN BND
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1021
Practice Address - Country:US
Practice Address - Phone:518-899-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72094716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker