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General NPI Number Information
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NPI Number | 1750428413
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Entity Type | Individual
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Provider Name | POONAM BALA DHARNI LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 12/21/2012
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Provider Practice Location Address
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Address Line | 2737 3RD AVE
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City | BRONX
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State | NY
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Zip | 10451-5801
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Country | US
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Telephone | 718-838-1029
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Fax | 718-838-1010
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Provider Business Mailing Address
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Address Line | 6207 84TH ST APT E61
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-2030
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Country | US
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Telephone | 310-383-9912
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 077887
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License Number State | NY
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