Healthcare Provider Details

I. General information

NPI: 1336307180
Provider Name (Legal Business Name): YVETTE SANTOS CUENCO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 16TH AVE IHB DAY TREATMENT CENTER @ PS 180
BROOKLYN NY
11204-1809
US

IV. Provider business mailing address

5601 16TH AVE IHB DAY TREATMENT CENTER @ PS 180
BROOKLYN NY
11204-1809
US

V. Phone/Fax

Practice location:
  • Phone: 718-686-1526
  • Fax: 718-854-1483
Mailing address:
  • Phone: 718-686-1526
  • Fax: 718-854-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: