Healthcare Provider Details

I. General information

NPI: 1437941705
Provider Name (Legal Business Name): DENITA BERNADETTE GOVIA MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 INDEPENDENCE AVE
BRONX NY
10463-4620
US

IV. Provider business mailing address

1805 BRUCKNER BLVD APT 6
BRONX NY
10472-6516
US

V. Phone/Fax

Practice location:
  • Phone: 718-506-1115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015225-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: