Provider Demographics
NPI:1083755532
Name:FONTANEZ, OBDULIA B (LMSW)
Entity Type:Individual
Prefix:
First Name:OBDULIA
Middle Name:B
Last Name:FONTANEZ
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 1:11 W GIBBONS STREET
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036
Mailing Address - Country:US
Mailing Address - Phone:646-496-6090
Mailing Address - Fax:718-405-8060
Practice Address - Street 1:1621 EASTCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:BRONX,
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-405-8040
Practice Address - Fax:718-405-8060
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0703591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical