Provider Demographics
NPI:1396010278
Name:PADWA, MIA DIAMOND (LMSW)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:DIAMOND
Last Name:PADWA
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 1:1 GATEWAY PLZ
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4674
Mailing Address - Country:US
Mailing Address - Phone:914-305-6847
Mailing Address - Fax:914-937-4860
Practice Address - Street 1:1 GATEWAY PLZ
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4674
Practice Address - Country:US
Practice Address - Phone:914-305-6847
Practice Address - Fax:914-937-4860
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076841-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker