Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 054120-1 | NY |
NPI | 1003061482 |
---|---|
Provider Name | Mrs. Stephanie Ann I Vivona Rafanelli |
First Address | Westbury, NY 11590-6216 |
Second Address | Westbury, NY 11590-6216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2008 |
Last Update Date | 26/11/2008 |