Healthcare Provider Details

I. General information

NPI: 1609665066
Provider Name (Legal Business Name): PROFOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 STEUBEN AVE
BRONX NY
10467-2806
US

IV. Provider business mailing address

5240 NETHERLAND AVE
BRONX NY
10471-2810
US

V. Phone/Fax

Practice location:
  • Phone: 914-618-4321
  • Fax:
Mailing address:
  • Phone: 718-884-6547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALERIE CARABALLO
Title or Position: PRESIDENT
Credential:
Phone: 914-618-4321