Basic Information
| Provider Information | |||||||||
| NPI: | 1477207975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALWYN | ||||||||
| FirstName: | JONDEAN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 EINSTEIN LOOP N | ||||||||
| Address2: | UNIT 26D | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176077303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 E 168TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104527929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182933900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2022 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 105017 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.