Basic Information
| Provider Information | |||||||||
| NPI: | 1700334208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURAN | ||||||||
| FirstName: | ISAMAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | VI | ||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 PARKVIEW TER APT 2L | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104681550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466857489 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 579 COURTLANDT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184852100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.