Basic Information
| Provider Information | |||||||||
| NPI: | 1174120356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IZQUIERDO | ||||||||
| FirstName: | ALISHA | ||||||||
| MiddleName: | SILVANNA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4305 KEPLER AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104702008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9177024976 | ||||||||
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| Practice Location | |||||||||
| Address1: | 579 COURTLANDT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184852100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2020 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.