Healthcare Provider Details

I. General information

NPI: 1376111278
Provider Name (Legal Business Name): SAFIYA DILLARD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 PARK AVE
NEW YORK NY
10029
US

IV. Provider business mailing address

611 W 163RD ST APT 4
NEW YORK NY
10032-5644
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax:
Mailing address:
  • Phone: 845-489-2032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110707
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: