Provider Demographics
NPI:1295742724
Name:HATHAWAY, WADE ANTHONY (LCSW)
Entity type:Individual
Prefix:MR
First Name:WADE
Middle Name:ANTHONY
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3218 CAMBRIDGE AVE
Mailing Address - Street 2:NO 3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:347-427-2988
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:5B-09-C, JJ PETERS VAMC,
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:718-741-4709
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-0688511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical