Provider Demographics
NPI:1881430080
Name:HUGHES, MICHAEL JOHN (LSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:HUGHES
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 W 186TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-8514
Mailing Address - Country:US
Mailing Address - Phone:201-988-5331
Mailing Address - Fax:
Practice Address - Street 1:736 W 186TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-8514
Practice Address - Country:US
Practice Address - Phone:201-988-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123872-01104100000X
NJ44SL07139500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty