Healthcare Provider Details

I. General information

NPI: 1497728729
Provider Name (Legal Business Name): MICHAEL T DEPAOLI JR. LCSWR
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 ADAMS STREET
BEDFORD HILLS NY
10507-2001
US

IV. Provider business mailing address

333 ADAMS STREET
BEDFORD HILLS NY
10507-2001
US

V. Phone/Fax

Practice location:
  • Phone: 914-242-0725
  • Fax: 914-242-5152
Mailing address:
  • Phone: 914-242-0725
  • Fax: 914-242-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR0345361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: