Provider Demographics
NPI:1063879815
Name:HYGEIA INTEGRATED HEALTH LLC
Entity type:Organization
Organization Name:HYGEIA INTEGRATED HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:DUBOSE
Authorized Official - Last Name:FOULKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R, MBA
Authorized Official - Phone:914-734-2205
Mailing Address - Street 1:26 SNIFFEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6404
Mailing Address - Country:US
Mailing Address - Phone:914-734-2205
Mailing Address - Fax:
Practice Address - Street 1:3505 HILL BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1283
Practice Address - Country:US
Practice Address - Phone:914-734-2205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0482531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN67921OtherMEDICARE PTAN