Provider Demographics
NPI:1396219218
Name:LAGOMBRA, DANILSA (LMSW)
Entity Type:Individual
Prefix:
First Name:DANILSA
Middle Name:
Last Name:LAGOMBRA
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 1:21824 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2247
Mailing Address - Country:US
Mailing Address - Phone:718-527-1825
Mailing Address - Fax:
Practice Address - Street 1:13630 219TH ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2229
Practice Address - Country:US
Practice Address - Phone:718-527-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096299104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker