LEYDI TATIANA FONSECA

ITHACA, NY
NPI1104449032
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: NY  095562-01)
Additional Taxonomies104100000X Social Worker
(Licence: NJ  44SL06397700)
1041C0700X Social Worker, Clinical
(Licence: NJ  44SC06006900)
Enumeration Date2020-05-27
Last Update Date2024-01-27
Business Address
LEYDI TATIANA FONSECA LCSW
212 HIGHGATE RD
ITHACA, NY 14850-1436
Phone number: 862-264-9284
Mailing Address
LEYDI TATIANA FONSECA LCSW
212 HIGHGATE RD
ITHACA, NY 14850-1436
Phone number: 862-264-9284