Healthcare Provider Details

I. General information

NPI: 1366195463
Provider Name (Legal Business Name): KARISMA OQUENDO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 REMSEN ST
BROOKLYN NY
11201-4333
US

IV. Provider business mailing address

2307 AVENUE U
BROOKLYN NY
11229-4916
US

V. Phone/Fax

Practice location:
  • Phone: 347-450-3776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011918
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: