Provider Demographics
NPI:1992136501
Name:NUNEZ, INGRID SHARON (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:SHARON
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 JOHNSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3539
Mailing Address - Country:US
Mailing Address - Phone:917-587-4819
Mailing Address - Fax:646-893-7767
Practice Address - Street 1:3265 JOHNSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3539
Practice Address - Country:US
Practice Address - Phone:646-204-6755
Practice Address - Fax:646-893-7767
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087769-1104100000X
NY085545-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05850977Medicaid