Healthcare Provider Details

I. General information

NPI: 1679266399
Provider Name (Legal Business Name): ISABELLA GRACE CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MADISON AVE FL 6
NEW YORK NY
10016-6795
US

IV. Provider business mailing address

210 W 89TH ST APT 10N
NEW YORK NY
10024-1809
US

V. Phone/Fax

Practice location:
  • Phone: 314-451-1440
  • Fax:
Mailing address:
  • Phone: 619-204-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: