Doctor Name: | MERRIT HARTBLAY |
NPI Number: | 1497126247 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CASAC |
License Number: | 26067 |
Business Practice Address: | 1062 State Route 38 Owego, NY - 138273209 |
Business Phone Number: | 6076874000 |
Business Fax Number: | |
Mailing Address: | 35 Mary St, Apartment B BINGHAMTON |
State: | NY |
Postal Code: | 139031707 |
Phone Number: | 5168528478 |
Fax Number: | |
NPI Enumeration Date: | 10/19/2015 |
NPI Last Update Date: | 10/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 26067 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |