Provider Demographics
NPI:1790149011
Name:UMANA, WALTER JOEL
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOEL
Last Name:UMANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13309 BOOTH MEMORIAL AVE
Mailing Address - Street 2:APT 8C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5137
Mailing Address - Country:US
Mailing Address - Phone:917-583-1127
Mailing Address - Fax:
Practice Address - Street 1:13309 BOOTH MEMORIAL AVE
Practice Address - Street 2:APT 8C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5137
Practice Address - Country:US
Practice Address - Phone:917-583-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst