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General NPI Number Information
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NPI Number | 1083967970
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Entity Type | Organization
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Legal Business Name | LATINO SUPPORT LCSW, P.C
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 4322 50 STREET SUITE 2C
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 718-505-1531
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Fax | 347-808-9871
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Provider Business Mailing Address
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Address Line | P.O. BOX 630333
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City | LITTLE NECK
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State | NY
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Zip | 11363
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Country | US
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Telephone | 718-505-1531
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Fax | 347-808-9871
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. MARIA T. SCHREIBER
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Credential | LCSW-R
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Telephone | 718-505-1531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 079970
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License Number State | NY
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