Healthcare Provider Details

I. General information

NPI: 1689844128
Provider Name (Legal Business Name): AMALIA LA PORTA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 CLARKSON AVE KINGSBORO PSYCHIATRIC CENTER
BROOKLYN NY
11203-2125
US

IV. Provider business mailing address

1114 46TH AVE APT. 3I
LONG ISLAND CITY NY
11101-5234
US

V. Phone/Fax

Practice location:
  • Phone: 718-388-3075
  • Fax: 718-388-4468
Mailing address:
  • Phone: 917-716-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number071526-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: