Healthcare Provider Details

I. General information

NPI: 1134207442
Provider Name (Legal Business Name): CORY CUOMO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 HOES LN
PISCATAWAY NJ
08854-5627
US

IV. Provider business mailing address

671 HOES LN P. O. BOX 1392
PISCATAWAY NJ
08854-5627
US

V. Phone/Fax

Practice location:
  • Phone: 800-969-5300
  • Fax:
Mailing address:
  • Phone: 732-235-5940
  • Fax: 732-235-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04948000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: