1346550084 NPI number — MS. MARIA EUGENIA VISBAL LCSW

Table of content: MS. MARIA EUGENIA VISBAL LCSW (NPI 1346550084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346550084 NPI number — MS. MARIA EUGENIA VISBAL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISBAL
Provider First Name:
MARIA
Provider Middle Name:
EUGENIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346550084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 FLATBUSH AVENUE
Provider Second Line Business Mailing Address:
SOUTH BEACH PSYCHIATRIC CENTER
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-875-1420
Provider Business Mailing Address Fax Number:
718-875-5496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 FLATBUSH AVENUE
Provider Second Line Business Practice Location Address:
SOUTH BEACH PSYCHIATRIC CENTER
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-875-1420
Provider Business Practice Location Address Fax Number:
718-875-5496
Provider Enumeration Date:
10/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  042398 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)