Provider Demographics
NPI:1598594335
Name:LEDEZMA, STEPHANIE ANNETTE (MSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNETTE
Last Name:LEDEZMA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 JACKSON AVE APT 4R
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4346
Mailing Address - Country:US
Mailing Address - Phone:817-629-1539
Mailing Address - Fax:
Practice Address - Street 1:510 JACKSON AVE APT 4R
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4346
Practice Address - Country:US
Practice Address - Phone:817-629-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool