Healthcare Provider Details

I. General information

NPI: 1306329503
Provider Name (Legal Business Name): EVELYN AQUINO PAGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 HARBOR RD UNIT B
COLD SPRING HARBOR NY
11724-2100
US

IV. Provider business mailing address

428 HARBOR RD UNIT B
COLD SPRING HARBOR NY
11724-2100
US

V. Phone/Fax

Practice location:
  • Phone: 908-346-7104
  • Fax:
Mailing address:
  • Phone: 908-346-7104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: