Healthcare Provider Details

I. General information

NPI: 1427504653
Provider Name (Legal Business Name): AGNES HUERTAS M.H.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 SHAKESPEARE AVE
BRONX NY
10452
US

IV. Provider business mailing address

80 LEIF BLVD
CONGERS NY
10920
US

V. Phone/Fax

Practice location:
  • Phone: 718-732-7080
  • Fax:
Mailing address:
  • Phone: 845-682-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: