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General NPI Number Information
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NPI Number | 1316611452
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Entity Type | Individual
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Provider Name | PAULA GAVIOTA TIRADO-MANSILLA LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 62-07 WOODSIDE AVENUE 2ND FLOOR
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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 | 718-476-0074
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Fax |
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Provider Business Mailing Address
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Address Line | 77 PROSPECT ST APT I
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City | GARFIELD
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State | NJ
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Zip | 07026-2545
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Country | US
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Telephone | 862-249-8568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 113307
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License Number State | NY
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