=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538483888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISITING SOCIAL WORK OF NEW YORK LCSW P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2010
-----------------------------------------------------
Last Update Date | 03/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 177 NAGLE AVE APT 14B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10034-6024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-281-2592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 GLENWOOD DR N
-----------------------------------------------------
City | BERGENFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07621-3346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-281-2592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. WANDA I MARQUEZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 646-281-2592
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 075249-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | 075249-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 075249-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------