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NPI Code Detail

MEDICARE: MR. GILBERTO SUERO LCSW

MEDICARE: MR. GILBERTO SUERO LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker079954NY

General Provider Information

NPI Number : 1336492917
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GILBERTO SUERO LCSW
Provider Business Mailing Address
First Line : 486 BUEL AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3330
Country : US
Telephone Number : 718-600-0316
Fax Number :
Provider Business Practice Location Address
First Line : 486 BUEL AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3330
Country : US
Telephone Number : 718-600-0316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2012
Last Update Date : 10/19/2012

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