=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659697787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALKA PAUL WALIA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2010
-----------------------------------------------------
Last Update Date | 04/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150-11 HILLSIDE AVE JAMAICA COMMUNITY SERVICES
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-739-5778
-----------------------------------------------------
Fax | 718-523-2728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6342 FITCHETT ST FL 1
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-263-1378
-----------------------------------------------------
Fax | 718-335-8016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 077094-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------