Healthcare Provider Details

I. General information

NPI: 1437677515
Provider Name (Legal Business Name): MINERVA SEPULVEDA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 35TH AVE APT 107W
JACKSON HEIGHTS NY
11372-8105
US

IV. Provider business mailing address

23938B OAK PARK DR
DOUGLASTON NY
11362-2626
US

V. Phone/Fax

Practice location:
  • Phone: 718-672-1538
  • Fax:
Mailing address:
  • Phone: 718-964-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number078953
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: