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General NPI Number Information
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NPI Number | 1679714372
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Entity Type | Individual
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Provider Name | ETHELORE CHIOMA SOW MSW
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Gender | Female
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/10/2009
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Provider Practice Location Address
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Address Line | 21 AUDUBON AVE 2ND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10032-4220
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Country | US
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Telephone | 212-305-2140
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Fax | 212-305-8210
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Provider Business Mailing Address
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Address Line | 1893 7TH AVE 6B
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City | NEW YORK
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State | NY
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Zip | 10026-2821
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Country | US
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Telephone | 212-395-2140
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Fax | 212-305-8210
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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 | 73036397
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License Number State | NY
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