=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952182099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REINA MARIA VIERA NAVARRO LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2023
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 CHAPMAN BLVD
-----------------------------------------------------
City | MANORVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11949-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-871-6515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 CHAPMAN BLVD
-----------------------------------------------------
City | MANORVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11949-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-871-6515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 121482-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------