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General NPI Number Information
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NPI Number | 1376087726
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Entity Type | Individual
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Provider Name | MYRNA TANIA DE LEON LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 2510 WESTCHESTER AVE SUITE 102
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City | BRONX
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State | NY
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Zip | 10461-3585
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Country | US
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Telephone | 171-859-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 LONGFELLOW AVE APT 4B
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City | BRONX
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State | NY
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Zip | 10460-5413
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Country | US
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Telephone | 137-571-4112
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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 | 096089
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License Number State | NY
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