Healthcare Provider Details

I. General information

NPI: 1861094260
Provider Name (Legal Business Name): MICHELLE ESPINAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 WASHINGTON ST
MOUNT VERNON NY
10553-1052
US

IV. Provider business mailing address

256 WASHINGTON ST
MOUNT VERNON NY
10553-1052
US

V. Phone/Fax

Practice location:
  • Phone: 914-613-0700
  • Fax:
Mailing address:
  • Phone: 914-613-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: