1982004909 NPI number — MR. FELIPE ERNESTO SEPULVEDA LCSW

Table of content: MR. FELIPE ERNESTO SEPULVEDA LCSW (NPI 1982004909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982004909 NPI number — MR. FELIPE ERNESTO SEPULVEDA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEPULVEDA
Provider First Name:
FELIPE
Provider Middle Name:
ERNESTO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1982004909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 CENTRE DR # 1023
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRAL VALLEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10917-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-377-2230
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 E158TH STREET APT 5G
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:
10451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-377-2230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2014

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:  092340 , 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)





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