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General NPI Number Information
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NPI Number | 1720378490
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Entity Type | Organization
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Legal Business Name | JOAN POELVOORDE LCSW PC
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 316 W 94TH ST APT 3B
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City | NEW YORK
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State | NY
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Zip | 10025-6857
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Country | US
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Telephone | 646-473-0138
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Fax | 646-473-0140
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Provider Business Mailing Address
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Address Line | 316 W 94TH ST APT 3B
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City | NEW YORK
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State | NY
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Zip | 10025-6855
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Country | US
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Telephone | 646-473-0138
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Fax | 646-473-0140
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MS. JOAN POELVOORDE
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Credential | LCSW
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Telephone | 646-473-0138
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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 | PR019774
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License Number State | NY
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