Healthcare Provider Details

I. General information

NPI: 1598286312
Provider Name (Legal Business Name): DAVID HUAMANCHA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 31ST ST FL 5
NEW YORK NY
10001-3596
US

IV. Provider business mailing address

8603 85TH ST FL 2
WOODHAVEN NY
11421-1214
US

V. Phone/Fax

Practice location:
  • Phone: 212-564-6006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091222
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: