Individual
CONNIE SEPULVEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
100 N VILLAGE AVE, SUITE 39, ROCKVILLE CENTRE, NY 11570-3767
(516) 546-7568
Mailing address
775 BONNIE DR, BALDWIN, NY 11510-4522
(516) 546-7568
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
029047-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VALUE OPTIONS
145717
NY
Enumeration date
01/17/2007
Last updated
07/08/2007
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