Provider Demographics
NPI:1477823268
Name:INES M MERCEDES-ALCANTARA L.C.S.W
Entity Type:Organization
Organization Name:INES M MERCEDES-ALCANTARA L.C.S.W
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-294-4725
Mailing Address - Street 1:2360 AMSTERDAM AVE
Mailing Address - Street 2:SUITE M-2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7362
Mailing Address - Country:US
Mailing Address - Phone:646-678-5222
Mailing Address - Fax:646-678-5119
Practice Address - Street 1:2360 AMSTERDAM AVE
Practice Address - Street 2:SUITE # M-2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7362
Practice Address - Country:US
Practice Address - Phone:646-678-5222
Practice Address - Fax:646-678-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO54425-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02764363Medicaid
NYA300037937OtherMEDICARE PTAN