Basic Information
| Provider Information | |||||||||
| NPI: | 1184264418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORPORAN CRESPO | ||||||||
| FirstName: | NATALIA | ||||||||
| MiddleName: | XEOMARA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 E 149 STREET | ||||||||
| Address2: | 7B - ADULT OUTPATIENT PSYCHIATRY | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795893 | ||||||||
| FaxNumber: | 7185795045 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 E 149 STREET | ||||||||
| Address2: | 7B - ADULT OUTPATIENT PSYCHIATRY | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795893 | ||||||||
| FaxNumber: | 7185795045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2020 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 107998 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.