Provider Demographics
NPI:1659687101
Name:PINA, VONALIS SORAYA (LCSW, MSED)
Entity Type:Individual
Prefix:MS
First Name:VONALIS
Middle Name:SORAYA
Last Name:PINA
Suffix:
Gender:F
Credentials:LCSW, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 FAIRFIELD AVE
Mailing Address - Street 2:APT. #7C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3242
Mailing Address - Country:US
Mailing Address - Phone:917-583-6396
Mailing Address - Fax:
Practice Address - Street 1:1545 INWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2001
Practice Address - Country:US
Practice Address - Phone:855-681-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0816281104100000X
NY0819131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1659687101Medicaid