Provider Demographics
NPI:1073850046
Name:TRINIDAD, IVETTE A (LMSW)
Entity Type:Individual
Prefix:MS
First Name:IVETTE
Middle Name:A
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SHEPHERD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1225
Mailing Address - Country:US
Mailing Address - Phone:646-407-0885
Mailing Address - Fax:
Practice Address - Street 1:42 SHEPHERD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1225
Practice Address - Country:US
Practice Address - Phone:646-407-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker