Healthcare Provider Details

I. General information

NPI: 1588250492
Provider Name (Legal Business Name): BETSY ENID OQUENDO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CARLTON AVE APT 6D
BROOKLYN NY
11205-2219
US

IV. Provider business mailing address

60 CARLTON AVE APT 6D
BROOKLYN NY
11205-2219
US

V. Phone/Fax

Practice location:
  • Phone: 917-582-3962
  • Fax:
Mailing address:
  • Phone: 917-582-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number01249901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: