=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477910800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UN PASO ADELANTE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2016
-----------------------------------------------------
Last Update Date | 01/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3314 OLD CAPITOL TRL OFC 2
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-6276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-306-8981
-----------------------------------------------------
Fax | 302-516-7672
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 RIVERBIRCH CIR
-----------------------------------------------------
City | KENNETT SQ
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-306-8981
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBIN NOEL TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-306-8981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | Q1-0001203
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------