Provider Demographics
NPI:1588847230
Name:TOLENTINO, XIOMARA GENOVEVA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:XIOMARA
Middle Name:GENOVEVA
Last Name:TOLENTINO
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 1:2488 GRAND CONCOURSE STE 2000
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5203
Mailing Address - Country:US
Mailing Address - Phone:718-881-7600
Mailing Address - Fax:718-515-8057
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-8282
Practice Address - Fax:718-515-8057
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00257805Medicaid