Healthcare Provider Details

I. General information

NPI: 1740127281
Provider Name (Legal Business Name): YENCY Y BUSTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 BATHGATE AVE
BRONX NY
10457-6259
US

IV. Provider business mailing address

1880 BATHGATE AVE
BRONX NY
10457-6259
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-5891
  • Fax: 718-294-2468
Mailing address:
  • Phone: 718-294-5891
  • Fax: 718-294-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP140214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: