Healthcare Provider Details

I. General information

NPI: 1043136823
Provider Name (Legal Business Name): VANESSA GUADALUPE BARRIENTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BEACH 17TH ST APT 3B
FAR ROCKAWAY NY
11691-4501
US

IV. Provider business mailing address

125 BEACH 17TH ST APT 3B
FAR ROCKAWAY NY
11691-4501
US

V. Phone/Fax

Practice location:
  • Phone: 212-602-1424
  • Fax:
Mailing address:
  • Phone: 212-602-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2511546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: