Provider Demographics
NPI:1437677515
Name:SEPULVEDA, MINERVA (LMSW)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:SEPULVEDA
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 1:23938B OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2612
Mailing Address - Country:US
Mailing Address - Phone:718-964-8451
Mailing Address - Fax:
Practice Address - Street 1:7410 35TH AVE APT 107W
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8105
Practice Address - Country:US
Practice Address - Phone:718-672-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078953-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical