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NPI Code Detail

MEDICARE: EMANUELA TANIA DA PRADA LMSW

MEDICARE: EMANUELA TANIA DA PRADA 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
11041C0700XClinical Social Worker075674NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040426033245OTHERNYFIDELIS PROVIDER NUMBER

General Provider Information

NPI Number : 1790891992
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMANUELA TANIA DA PRADA LMSW
Provider Business Mailing Address
First Line : 217 HAVEMEYER STREET
Second Line : 4TH FLOOR
City : BROOKLYN
State : NY
Zip : 11211
Country : US
Telephone Number : 718-963-4430
Fax Number : 718-963-0814
Provider Business Practice Location Address
First Line : 217 HAVEMEYER ST
Second Line : 4TH FLOOR
City : BROOKLYN
State : NY
Zip : 11211-6277
Country : US
Telephone Number : 718-963-4430
Fax Number : 718-963-0814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/08/2007

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