Healthcare Provider Details

I. General information

NPI: 1902125438
Provider Name (Legal Business Name): ECENA CUETO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FIELDSTON ROAD
BRONX NY
10463
US

IV. Provider business mailing address

419 SAINT LAWRENCE AVE 2
BRONX NY
10473-3605
US

V. Phone/Fax

Practice location:
  • Phone: 917-518-5329
  • Fax:
Mailing address:
  • Phone: 917-518-5329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005028
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: