Healthcare Provider Details

I. General information

NPI: 1013883636
Provider Name (Legal Business Name): MARLENE CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 ALBION ST
BRIDGEPORT CT
06605-2602
US

IV. Provider business mailing address

46 ALBION ST
BRIDGEPORT CT
06605-2602
US

V. Phone/Fax

Practice location:
  • Phone: 845-664-3367
  • Fax:
Mailing address:
  • Phone: 845-664-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0011004
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: