Healthcare Provider Details

I. General information

NPI: 1477783793
Provider Name (Legal Business Name): URSULA LLAMAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 3RD AVE JWJ COUNSELING CENTER
NEW YORK NY
10029-2117
US

IV. Provider business mailing address

2089 3RD AVE JWJ COUNSELING CENTER
NEW YORK NY
10029-2117
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-6144
  • Fax:
Mailing address:
  • Phone: 212-828-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number052709
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73080608
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: