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General NPI Number Information
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NPI Number | 1003060013
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Entity Type | Organization
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Legal Business Name | JOAN POELVOORDE LCSW PC
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 19 W 34TH ST PENTHOUSE
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 646-473-0138
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Fax | 646-473-0138
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | KINGS PARK
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State | NY
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Zip | 11754-0265
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Country | US
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Telephone | 646-473-0138
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Fax | 646-473-0140
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | JOAN POELVOORDE
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Credential | LCSW
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Telephone | 646-473-0138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PR019774
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License Number State | NY
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