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General NPI Number Information
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NPI Number | 1336673714
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Entity Type | Individual
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Provider Name | JANISE LYDIA KANGOMBE LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 11416 103RD AVE APT2
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1828
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Country | US
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Telephone | 646-657-6978
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Fax |
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Provider Business Mailing Address
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Address Line | 120 BEACH 26TH ST APT 613
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-2237
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Country | US
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Telephone | 347-576-8201
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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 | 0970891
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License Number State | NY
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