=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043663156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDREI ADRIANNI CONTON-PELAEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2016
-----------------------------------------------------
Last Update Date | 07/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 BROADWAY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11211-8433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-505-5196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 552 W 188TH ST APT 31
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10040-4556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-359-8608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | P02655
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------