Provider Demographics
NPI:1184264418
Name:CORPORAN CRESPO, NATALIA XEOMARA (LMSW)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:XEOMARA
Last Name:CORPORAN CRESPO
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 1:234 E 149 STREET
Mailing Address - Street 2:7B - ADULT OUTPATIENT PSYCHIATRY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:718-579-5893
Mailing Address - Fax:718-579-5045
Practice Address - Street 1:234 E 149 STREET
Practice Address - Street 2:7B - ADULT OUTPATIENT PSYCHIATRY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5893
Practice Address - Fax:718-579-5045
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107998104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker