1124107743 NPI number — MRS. PILAR M VERDESOTO LCSW R

Table of content: MRS. PILAR M VERDESOTO LCSW R (NPI 1124107743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124107743 NPI number — MRS. PILAR M VERDESOTO LCSW R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERDESOTO
Provider First Name:
PILAR
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW R
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:
1124107743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
471 HILLTOP ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORKTOWN HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-245-9044
Provider Business Mailing Address Fax Number:
914-245-3091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3651 HILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON VALLEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-245-3091
Provider Business Practice Location Address Fax Number:
914-245-3091
Provider Enumeration Date:
11/03/2006

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:  R0391951 , 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)

  • Identifier: 0086863J , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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