Provider Demographics
NPI:1972125151
Name:PEDRO, TEMITAYO (LMSW)
Entity Type:Individual
Prefix:
First Name:TEMITAYO
Middle Name:
Last Name:PEDRO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TEMI
Other - Middle Name:
Other - Last Name:PEDRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:50 COURT ST # 901
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4879
Mailing Address - Country:US
Mailing Address - Phone:201-503-5890
Mailing Address - Fax:
Practice Address - Street 1:50 COURT ST STE 901
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4879
Practice Address - Country:US
Practice Address - Phone:347-328-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0775301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical