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NPI Code Detail

MEDICARE: MS. XOCHITL DOLORES ROA LCSW-R

MEDICARE: MS. XOCHITL DOLORES ROA LCSW-R
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 Worker073481-1NY

General Provider Information

NPI Number : 1538170576
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. XOCHITL DOLORES ROA LCSW-R
Provider Business Mailing Address
First Line : 819 GRAND ST
Second Line : TOP FLOOR
City : BROOKLYN
State : NY
Zip : 11211-5001
Country : US
Telephone Number : 718-388-5176
Fax Number :
Provider Business Practice Location Address
First Line : 819 GRAND ST
Second Line : TOP FLOOR
City : BROOKLYN
State : NY
Zip : 11211-5001
Country : US
Telephone Number : 718-388-5176
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 11/15/2010

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Directions to “ MS. XOCHITL DOLORES ROA LCSW-R” Practice Location

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