Provider Demographics
NPI:1760662704
Name:HARTLEY-BANGS, LORETTA MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:MARY
Last Name:HARTLEY-BANGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 49TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2049
Mailing Address - Country:US
Mailing Address - Phone:631-225-1123
Mailing Address - Fax:516-742-4620
Practice Address - Street 1:366 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1612
Practice Address - Country:US
Practice Address - Phone:516-742-4015
Practice Address - Fax:516-742-4620
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0376481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical