=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124107743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PILAR M VERDESOTO LCSW R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3651 HILL BLVD
-----------------------------------------------------
City | JEFFERSON VALLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-245-3091
-----------------------------------------------------
Fax | 914-245-3091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 471 HILLTOP ROAD
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-245-9044
-----------------------------------------------------
Fax | 914-245-3091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R0391951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------