Peacock, Tawanna

Peacock, Tawanna is an individual health care provider with primary practice located at 729 E 230Th St , Bronx NY 10466-4103. She recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as her primary health care specialty. Peacock, Tawanna can be contacted via phone (917) 405-6086.

Contact Information

Primary practice address
729 E 230Th St Bronx NY 10466-4103
Phone: (917) 405-6086
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1205040433
LBN Legal business name Peacock, Tawanna
Credentials LMSW
Entity Individual
Sole proprietor 1 No
Enumeration date May 9th, 2007
Last updated Aug 16th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205040433 NPPES
New York Other 00355940 AGENCY MEDICAID
New York Other 1285628552 AGENCY MEDICAID

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