Provider Demographics
NPI:1831809631
Name:ESSENTIAL ADIRONDACK THERAPY LICENSE CLINICAL SOCIAL WORK, PLLC.
Entity type:Organization
Organization Name:ESSENTIAL ADIRONDACK THERAPY LICENSE CLINICAL SOCIAL WORK, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/ OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HURLBURT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-572-9920
Mailing Address - Street 1:63 ROSCOE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-2407
Mailing Address - Country:US
Mailing Address - Phone:518-572-9920
Mailing Address - Fax:
Practice Address - Street 1:128 CORLEAR DR
Practice Address - Street 2:
Practice Address - City:WILLSBORO
Practice Address - State:NY
Practice Address - Zip Code:12996-4144
Practice Address - Country:US
Practice Address - Phone:518-420-5671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)