Healthcare Provider Details

I. General information

NPI: 1164185229
Provider Name (Legal Business Name): CHARLES SANGUEZA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 QUEENS BLVD STE 200
FOREST HILLS NY
11375-3694
US

IV. Provider business mailing address

890 GARRISON AVE FL 3
BRONX NY
10474-5332
US

V. Phone/Fax

Practice location:
  • Phone: 866-404-6913
  • Fax:
Mailing address:
  • Phone: 929-252-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110156
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: