| Support Evaluation And Intervention Services Lcsw P.c | |
|
4035 Junction Blvd Corona NY 11368-2121 | |
| (917) 995-3773 | |
| (212) 656-1412 |
| Full Name | Support Evaluation And Intervention Services Lcsw P.c |
|---|---|
| Speciality | Social Worker |
| Location | 4035 Junction Blvd, Corona, New York |
| Authorized Official Name and Position | Karina Pena-toledo (PRESIDENT) |
| Authorized Official Contact | 9179953773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Support Evaluation And Intervention Services Lcsw P.c 4035 Junction Blvd Corona NY 11368-2121 Ph: (917) 995-3773 | Support Evaluation And Intervention Services Lcsw P.c 4035 Junction Blvd Corona NY 11368-2121 Ph: (917) 995-3773 |
| NPI Number | 1790185395 |
|---|---|
| Provider Enumeration Date | 09/02/2014 |
| Last Update Date | 03/10/2017 |
| Medicare PECOS PAC ID | 9436475084 |
|---|---|
| Medicare Enrollment ID | O20150226001029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790185395 | NPI | - | NPPES |
| 1578717575 | Other | NY | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 080647-1 (New York) | Primary |
| Provider Name | Karina Alejandra Pena-toledo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578717575 PECOS PAC ID: 4486871837 Enrollment ID: I20150226001154 |
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