Provider Demographics
NPI:1790149011
Name:UMANA, WALTER JOEL
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:JOEL
Last Name:UMANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 225TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2042
Mailing Address - Country:US
Mailing Address - Phone:917-583-1127
Mailing Address - Fax:
Practice Address - Street 1:5747 225TH ST FL 2
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2042
Practice Address - Country:US
Practice Address - Phone:917-583-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY003054103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst