Healthcare Provider Details

I. General information

NPI: 1639471980
Provider Name (Legal Business Name): ALMA E WITHIM LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 05/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WORTH ST FL 5
NEW YORK NY
10013-2955
US

IV. Provider business mailing address

1276 FULTON AVE RM 208
BRONX NY
10456-3402
US

V. Phone/Fax

Practice location:
  • Phone: 646-619-6699
  • Fax: 646-619-6782
Mailing address:
  • Phone: 718-901-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR039339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: