Healthcare Provider Details

I. General information

NPI: 1750467635
Provider Name (Legal Business Name): MARIA P CUEVAS-ROGAT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 65 TH STREET APT 2
WEST NEW YORK NJ
07093-4103
US

IV. Provider business mailing address

33-65 STREET APT 2
WEST NEW YORK NJ
07093-4103
US

V. Phone/Fax

Practice location:
  • Phone: 201-868-1573
  • Fax:
Mailing address:
  • Phone: 201-868-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088331
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: