Provider Demographics
NPI:1427427616
Name:HILDWEIN, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HILDWEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2115
Mailing Address - Country:US
Mailing Address - Phone:845-229-6022
Mailing Address - Fax:
Practice Address - Street 1:15 MOUNT CARMEL PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1714
Practice Address - Country:US
Practice Address - Phone:845-485-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073275-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical