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General NPI Number Information
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NPI Number | 1639778624
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Entity Type | Individual
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Provider Name | BERTA ALICIA GARCIA BUSTAMANTE LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 07/01/2023
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Provider Practice Location Address
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Address Line | 96 W HOUSTON ST STE 1F
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City | NEW YORK
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State | NY
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Zip | 10012-2553
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Country | US
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Telephone | 929-265-1009
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Fax |
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Provider Business Mailing Address
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Address Line | 5 UNION SQUARE WEST FRONT 1, #1148
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City | NEW YORK
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State | NY
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Zip | 10003
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Country | US
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Telephone | 917-293-8494
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 110003
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License Number State | NY
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