Healthcare Provider Details

I. General information

NPI: 1053121566
Provider Name (Legal Business Name): CONNIE D DAYANARA URGILES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 91ST ST STE 3A
JACKSON HEIGHTS NY
11372-7962
US

IV. Provider business mailing address

3 GRANADA CRES APT 3-10
WHITE PLAINS NY
10603-1224
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-2263
  • Fax:
Mailing address:
  • Phone: 646-732-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number126319-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: