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NPI Code Detail

MEDICARE: TARA ELIZABETH BUENTELLO LCSW

MEDICARE: TARA ELIZABETH BUENTELLO 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 Worker085006NY

General Provider Information

NPI Number : 1841812880
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA ELIZABETH BUENTELLO LCSW
Provider Business Mailing Address
First Line : 1025 SENECA AVE
Second Line :
City : RIDGEWOOD
State : NY
Zip : 11385-5800
Country : US
Telephone Number : 646-980-0539
Fax Number :
Provider Business Practice Location Address
First Line : 1025 SENECA AVE
Second Line :
City : RIDGEWOOD
State : NY
Zip : 11385-5800
Country : US
Telephone Number : 646-980-0539
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2020
Last Update Date : 08/27/2021

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Directions to “ TARA ELIZABETH BUENTELLO LCSW” Practice Location

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