Healthcare Provider Details

I. General information

NPI: 1265908438
Provider Name (Legal Business Name): TRICIA T LYTTLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 161ST ST
BRONX NY
10451-3535
US

IV. Provider business mailing address

305 E 161ST ST
BRONX NY
10451-3535
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-2500
  • Fax:
Mailing address:
  • Phone: 718-579-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0948111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: