Provider Demographics
NPI:1720120629
Name:HULBERT COUNSELING SERVICES LCSW PC
Entity Type:Organization
Organization Name:HULBERT COUNSELING SERVICES LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER,VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HULBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:716-484-9840
Mailing Address - Street 1:517 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5323
Mailing Address - Country:US
Mailing Address - Phone:716-484-9840
Mailing Address - Fax:716-664-5186
Practice Address - Street 1:517 SPRING ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5323
Practice Address - Country:US
Practice Address - Phone:716-484-9840
Practice Address - Fax:716-664-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO375051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331451OtherMHN
NY6209032OtherINDEPENDENT HEALTH
NY331451OtherMHN