=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376004994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARON DOWDELL LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2019
-----------------------------------------------------
Last Update Date | 03/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 MAIN ST APT 203
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-7020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-343-8894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 MAIN ST APT 203
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-7020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-343-8894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 103319-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------