Healthcare Provider Details

I. General information

NPI: 1295397115
Provider Name (Legal Business Name): ABENAMAR GOICO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 3RD AVE
BRONX NY
10457-6222
US

IV. Provider business mailing address

145 W 15TH ST FL 2
NEW YORK NY
10011-6701
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-3045
  • Fax: 646-565-9491
Mailing address:
  • Phone: 212-924-6320
  • Fax: 646-306-0513

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 Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: