Healthcare Provider Details

I. General information

NPI: 1477756559
Provider Name (Legal Business Name): GRACE PADILLA-MATTHEW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E 64TH ST
NEW YORK NY
10021-6704
US

IV. Provider business mailing address

2920 BOUCK AVE
BRONX NY
10469-5211
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-5221
  • Fax: 212-535-7699
Mailing address:
  • Phone: 212-535-5221
  • Fax: 212-535-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number068088-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: