Provider Demographics
NPI:1578957437
Name:URENA, GEOVALIN
Entity Type:Individual
Prefix:
First Name:GEOVALIN
Middle Name:
Last Name:URENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 SEDGWICK AVE
Mailing Address - Street 2:APT. 15G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3975 SEDGWICK AVE
Practice Address - Street 2:APT. 15G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3105
Practice Address - Country:US
Practice Address - Phone:718-549-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089231104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker