Provider Demographics
NPI:1770648800
Name:PURDELL-HECKATHORN, JUDITH R (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:R
Last Name:PURDELL-HECKATHORN
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:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-0722
Mailing Address - Country:US
Mailing Address - Phone:845-863-7792
Mailing Address - Fax:
Practice Address - Street 1:26 CRITTENDEN ST
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-3112
Practice Address - Country:US
Practice Address - Phone:845-863-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073465-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical