Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 073105 | NY |
NPI | 1003013905 |
---|---|
Provider Name | Ms. Antonia Depalma-Brandt |
First Address | Forest Hills, NY 11375-3629 |
Second Address | New York, NY 10010-7002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 13/04/2010 |