Individual
ATHENA MOTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LCSW-R
Contact information
Practice address
15440 25TH AVE, WHITESTONE, NY 11357-3751
(347) 368-4758
Mailing address
15440 25TH AVE, WHITESTONE, NY 11357-3751
(347) 368-4758
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R044975-1
NY
Other
Enumeration date
06/09/2015
Last updated
06/09/2015
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