Basic Information
| Provider Information | |||||||||
| NPI: | 1194253385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEIDER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ALLAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128013624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189267200 | ||||||||
| FaxNumber: | 5189267036 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128013624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189267200 | ||||||||
| FaxNumber: | 5189267036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.