1073989570 NPI number — MISS LAURA MARIA LUCIANO LMSW

Table of content: MISS LAURA MARIA LUCIANO LMSW (NPI 1073989570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073989570 NPI number — MISS LAURA MARIA LUCIANO LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCIANO
Provider First Name:
LAURA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMSW
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:
1073989570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 WADSWORTH AVE APT 1C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10040-4171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-796-5300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5676 RIVERDALE AVE SUITE 202
Provider Second Line Business Practice Location Address:
RIVERDALE MENTAL HEALTH ASSOCIATION
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-796-5300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2015

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:  095503-1 , 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)