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Organization
SUPPORT EVALUATION AND INTERVENTION SERVICES LCSW P.C
Active
Organization
SUPPORT EVALUATION AND INTERVENTION SERVICES LCSW P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARINA PENA-TOLEDO LCSW (PRESIDENT)
(917) 995-3773
Entity
Organization
Contact information
Practice address
4035 JUNCTION BLVD, CORONA, NY 11368-2121
(917) 995-3773
(212) 656-1412
Mailing address
4035 JUNCTION BLVD, CORONA, NY 11368-2121
(917) 995-3773
(212) 656-1412
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
080647-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578717575
NPI
NY
Enumeration date
09/02/2014
Last updated
03/10/2017
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