Healthcare Provider Details

I. General information

NPI: 1417088766
Provider Name (Legal Business Name): ADELA GARCES INEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 GRAND CONCOURSE ROOM 823
BRONX NY
10453-4304
US

IV. Provider business mailing address

557 W 187TH ST 3
NEW YORK NY
10033-1343
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-0312
  • Fax: 718-583-4080
Mailing address:
  • Phone: 212-928-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR043490-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: