Provider Demographics
NPI:1235271271
Name:CEPEDA, CARMEN (LCSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JACOBUS PL
Mailing Address - Street 2:APT 6D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6809
Mailing Address - Country:US
Mailing Address - Phone:914-995-5233
Mailing Address - Fax:
Practice Address - Street 1:100 EAST 1ST ST 7TH FL
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-813-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058708-31041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7J621Medicare UPIN