Provider Demographics
NPI:1447355128
Name:DIVINO, LILY ANN MENDOZA (LMSW, MPH)
Entity type:Individual
Prefix:MS
First Name:LILY ANN
Middle Name:MENDOZA
Last Name:DIVINO
Suffix:
Gender:F
Credentials:LMSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5604
Mailing Address - Country:US
Mailing Address - Phone:212-423-2900
Mailing Address - Fax:212-423-2920
Practice Address - Street 1:312 E 94TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5604
Practice Address - Country:US
Practice Address - Phone:212-423-2900
Practice Address - Fax:212-423-2920
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070899104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070899OtherLICENSE #: