Provider Demographics
NPI:1962757328
Name:TIRADO, JANETTE (LMSW)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:TIRADO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:
Other - Last Name:TIRADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:31-36 88TH STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1415
Mailing Address - Country:US
Mailing Address - Phone:718-205-1919
Mailing Address - Fax:718-205-0178
Practice Address - Street 1:31-36 88TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11369-1415
Practice Address - Country:US
Practice Address - Phone:718-205-1919
Practice Address - Fax:718-205-0178
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-0588991041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool