1578021127 NPI number — GWENETH LOURECIA DESUZA SOCIAL WORKER

Table of content: GWENETH LOURECIA DESUZA SOCIAL WORKER (NPI 1578021127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578021127 NPI number — GWENETH LOURECIA DESUZA SOCIAL WORKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESUZA
Provider First Name:
GWENETH
Provider Middle Name:
LOURECIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SOCIAL WORKER
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:
1578021127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 W MOSHOLU PKWY S APT 35G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10468-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-839-1224
Provider Business Mailing Address Fax Number:
718-367-9582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 W MOSHOLU PKWY S APT 35G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-839-1224
Provider Business Practice Location Address Fax Number:
718-367-9582
Provider Enumeration Date:
03/02/2019

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: 104100000X , with the licence number:  075254-1 , 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)





Copyright © 2007-2025 www.npivalidator.com