Healthcare Provider Details

I. General information

NPI: 1497178396
Provider Name (Legal Business Name): IGNACIA URENA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 ONDERDONK AVE
RIDGEWOOD NY
11385-2207
US

IV. Provider business mailing address

8933 91ST ST
WOODHAVEN NY
11421-2625
US

V. Phone/Fax

Practice location:
  • Phone: 718-456-7777
  • Fax: 347-889-6989
Mailing address:
  • Phone: 917-774-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number068291-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: