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General NPI Number Information
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NPI Number | 1831341114
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Entity Type | Individual
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Provider Name | GABRIEL SANTISTEBAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 801 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025-5752
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Country | US
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Telephone | 212-316-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 13219 84TH ST
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City | OZONE PARK
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State | NY
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Zip | 11417-1917
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Country | US
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Telephone | 646-369-8087
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 079698
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License Number State | NY
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