Provider Demographics
NPI:1366567992
Name:HULBERT, F. RANDOLPH (LCSW)
Entity type:Individual
Prefix:MR
First Name:F.
Middle Name:RANDOLPH
Last Name:HULBERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:FREDERICK
Other - Middle Name:RANDOLPH
Other - Last Name:HULBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:14 MARI LN
Mailing Address - Street 2:
Mailing Address - City:FREWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14738-9524
Mailing Address - Country:US
Mailing Address - Phone:716-569-2077
Mailing Address - Fax:716-664-5186
Practice Address - Street 1:517 SPRING ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5323
Practice Address - Country:US
Practice Address - Phone:716-484-9840
Practice Address - Fax:716-664-5186
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0358231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical