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General NPI Number Information
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NPI Number | 1952536286
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Entity Type | Individual
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Provider Name | MARIA L BOLANOS-TAMAYO LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 825 W END AVE
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City | NEW YORK
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State | NY
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Zip | 10025-5349
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Country | US
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Telephone | 917-741-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 132 DRYER RD
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City | HURLEYVILLE
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State | NY
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Zip | 12747
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Country | US
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Telephone | 845-434-0262
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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 | 036338-1
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License Number State | NY
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