Healthcare Provider Details

I. General information

NPI: 1720628399
Provider Name (Legal Business Name): DENNIS FAGUNDO-OJEDA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL STE 310
BRONX NY
10461-2727
US

IV. Provider business mailing address

20 HALLETTS PT APT 1010
ASTORIA NY
11102-5094
US

V. Phone/Fax

Practice location:
  • Phone: 617-744-8542
  • Fax:
Mailing address:
  • Phone: 787-560-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY5000502
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number027485
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: