Provider Demographics
NPI:1093924961
Name:MIRO-QUESADA, LUCY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:A
Last Name:MIRO-QUESADA
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 1:63109 SAUNDERS ST APT F17
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3133
Mailing Address - Country:US
Mailing Address - Phone:718-997-0271
Mailing Address - Fax:
Practice Address - Street 1:119 W 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4920
Practice Address - Country:US
Practice Address - Phone:212-932-2676
Practice Address - Fax:212-864-5087
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072978-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical