=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356216105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FELIPE SEPULVEDA, LCSW, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2025
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 ROUTE 211 E STE 1009
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-2270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-943-2703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 470 ROUTE 211 E STE 1009
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-2270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-943-2703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FELIPE SEPULVEDA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 646-943-2703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------