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General NPI Number Information
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NPI Number | 1457922544
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Entity Type | Individual
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Provider Name | KARIDIATA CISSE LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 1626 PUTNEY RD
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City | VALLEY STREAM
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State | NY
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Zip | 11580-1818
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Country | US
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Telephone | 718-618-5075
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Fax | 929-900-1522
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Provider Business Mailing Address
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Address Line | 205 W 140TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10030-1771
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Country | US
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Telephone | 646-575-6852
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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 | 112741
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License Number State | NY
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