Healthcare Provider Details

I. General information

NPI: 1124509849
Provider Name (Legal Business Name): MS. LUZ CEPEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 MYRTLE AVE
BROOKLYN NY
11221-3211
US

IV. Provider business mailing address

1226 MYRTLE AVE
BROOKLYN NY
11221-3211
US

V. Phone/Fax

Practice location:
  • Phone: 347-703-5805
  • Fax: 202-600-7618
Mailing address:
  • Phone: 347-703-5805
  • Fax: 202-600-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130531
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: