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General NPI Number Information
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NPI Number | 1700283595
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Entity Type | Individual
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Provider Name | SOBEYDA VALLE-ELLIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/23/2014
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Last Update Date | 11/23/2014
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Provider Practice Location Address
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Address Line | 2115 34TH AVE APT 2A
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City | ASTORIA
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State | NY
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Zip | 11106-4365
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Country | US
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Telephone | 917-922-8821
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Fax | 718-726-2426
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Provider Business Mailing Address
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Address Line | 280 MADISON AVE SUITE 208
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City | NEW YORK
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State | NY
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Zip | 10016-0801
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Country | US
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Telephone | 917-922-8821
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Fax | 718-726-2426
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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 | 044375
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License Number State | NY
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