Basic Information
| Provider Information | |||||||||
| NPI: | 1083755532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FONTANEZ | ||||||||
| FirstName: | OBDULIA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 W GIBBONS STREET | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464966090 | ||||||||
| FaxNumber: | 7184058060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1621 EASTCHESTER ROAD | ||||||||
| Address2: | |||||||||
| City: | BRONX, | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184058040 | ||||||||
| FaxNumber: | 7184058060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 070359 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.