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General NPI Number Information
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NPI Number | 1821630856
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Entity Type | Individual
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Provider Name | LAURA J DEINNOCENTIIS LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 96 W HOUSTON ST FRNT 1
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City | NEW YORK
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State | NY
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Zip | 10012-2553
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Country | US
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Telephone | 347-885-3122
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Fax |
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Provider Business Mailing Address
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Address Line | 218 67TH ST # 1F
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City | BROOKLYN
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State | NY
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Zip | 11220-4824
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Country | US
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Telephone | 347-885-3122
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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 | 107548
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License Number State | NY
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