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General NPI Number Information
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NPI Number | 1518141415
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Entity Type | Individual
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Provider Name | MICHAEL DE VIDAS DSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 1 GUSTAVE L. LEVY PLACE BOX 1059-MOUNT SINAI MEDICAL CENTER
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City | NEW YORK
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State | NY
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Zip | 10029-6574
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Country | US
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Telephone | 212-241-9053
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Fax | 212-987-1134
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Provider Business Mailing Address
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Address Line | 1 GUSTAVE L. LEVY PLACE BOX 1059-MOUNT SINAI MEDICAL CENTER
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City | NEW YORK
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State | NY
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Zip | 10029-6574
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Country | US
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Telephone | 212-241-9053
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Fax | 212-987-1134
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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 | 034600-1R
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SC05214500
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License Number State | NJ
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