Healthcare Provider Details

I. General information

NPI: 1699246017
Provider Name (Legal Business Name): NEIL BUENO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 E 29TH ST FL 2
BROOKLYN NY
11210-2927
US

IV. Provider business mailing address

858 E 29TH ST FL 2
BROOKLYN NY
11210-2927
US

V. Phone/Fax

Practice location:
  • Phone: 718-859-4500
  • Fax:
Mailing address:
  • Phone: 718-859-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number085376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: