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General NPI Number Information
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NPI Number | 1629750559
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Entity Type | Individual
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Provider Name | IVETTE HURTADO
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Gender | Female
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 315 WYCKOFF AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-5384
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Country | US
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Telephone | 719-497-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 11814 83RD AVE APT 6J
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City | KEW GARDENS
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State | NY
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Zip | 11415-1308
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Country | US
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Telephone | 929-453-8784
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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 | P123390
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License Number State | NY
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