MEDICARE: DAPHNE ST VALLIERE LMSW

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
1	104100000X	Social Worker	257754	KY
2	104100000X	Social Worker	102235	NY

General Provider Information

NPI Number	:	1649951492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAPHNE ST VALLIERE LMSW

Provider Business Mailing Address
First Line	:	408 W 145TH ST APT 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-5202
Country	:	US
Telephone Number	:	347-577-2306
Fax Number	:

Provider Business Practice Location Address
First Line	:	273 W 138TH ST APT 2A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2167
Country	:	US
Telephone Number	:	347-577-2306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	03/08/2024

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Directions to “ DAPHNE ST VALLIERE LMSW” Practice Location

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