Healthcare Provider Details

I. General information

NPI: 1821145004
Provider Name (Legal Business Name): ROBERTO TOLEDO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 HANCOCK ST
BRENTWOOD NY
11717-2854
US

IV. Provider business mailing address

253 FELLER DR
CENTRAL ISLIP NY
11722-1213
US

V. Phone/Fax

Practice location:
  • Phone: 631-334-4299
  • Fax: 866-422-9552
Mailing address:
  • Phone: 631-334-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075458-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number068017-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17158
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: