Provider Demographics
NPI:1790017275
Name:WARE, LEDORA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LEDORA
Middle Name:
Last Name:WARE
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 1:4260 MAIN STREET
Mailing Address - Street 2:APARTMENT 4O
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4741
Mailing Address - Country:US
Mailing Address - Phone:718-463-5394
Mailing Address - Fax:
Practice Address - Street 1:234 EAST 149 STREET
Practice Address - Street 2:1 B2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053079104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker