Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003378589 |
---|---|
Provider Name | Cynthia Gangotena |
First Address | Brooklyn, NY 11211-3238 |
Second Address | Brooklyn, NY 11207-1610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |