Healthcare Provider Details

I. General information

NPI: 1588847230
Provider Name (Legal Business Name): XIOMARA GENOVEVA TOLENTINO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

2488 GRAND CONCOURSE STE 2000
BRONX NY
10458-5203
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-8282
  • Fax: 718-515-8057
Mailing address:
  • Phone: 718-881-7600
  • Fax: 718-515-8057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number074739
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: