Healthcare Provider Details

I. General information

NPI: 1699862292
Provider Name (Legal Business Name): YENDRA BERLINA VALENZUELA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 LAFAYETTE AVE
BRONX NY
10474-5336
US

IV. Provider business mailing address

1241 LAFAYETTE AVE
BRONX NY
10474-5336
US

V. Phone/Fax

Practice location:
  • Phone: 718-378-6500
  • Fax: 718-993-0647
Mailing address:
  • Phone: 718-378-6500
  • Fax: 718-993-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: