Provider Demographics
NPI:1497178396
Name:URENA, IGNACIA (LMSW)
Entity Type:Individual
Prefix:
First Name:IGNACIA
Middle Name:
Last Name:URENA
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 1:8933 91ST ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2625
Mailing Address - Country:US
Mailing Address - Phone:917-774-0875
Mailing Address - Fax:
Practice Address - Street 1:666 ONDERDONK AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2207
Practice Address - Country:US
Practice Address - Phone:718-456-7777
Practice Address - Fax:347-889-6989
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068291-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical