Healthcare Provider Details

I. General information

NPI: 1568616639
Provider Name (Legal Business Name): ANGEL LOUIS CUEVAS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2008
Last Update Date: 11/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 184TH ST
FRESH MEADOWS NY
11366-1714
US

IV. Provider business mailing address

7575 184TH ST
FRESH MEADOWS NY
11366-1714
US

V. Phone/Fax

Practice location:
  • Phone: 718-454-8875
  • Fax: 718-454-8875
Mailing address:
  • Phone: 718-454-8875
  • Fax: 718-454-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR065624-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: