Provider Demographics
NPI:1760528178
Name:SEPULVEDA, WILFREDO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 23 108 ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1226
Mailing Address - Country:US
Mailing Address - Phone:718-846-6779
Mailing Address - Fax:718-441-4468
Practice Address - Street 1:85 23 108 ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1226
Practice Address - Country:US
Practice Address - Phone:718-846-6779
Practice Address - Fax:718-441-4468
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0486471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist