Basic Information
| Provider Information | |||||||||
| NPI: | 1861910887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONCE | ||||||||
| FirstName: | ERNESTO | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 CARPENTER AVE APT 5 | ||||||||
| Address2: | |||||||||
| City: | SEA CLIFF | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115791338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163133076 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24302 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | LITTLE NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113621150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184236200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2017 | ||||||||
| LastUpdateDate: | 08/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 101269-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.