Healthcare Provider Details

I. General information

NPI: 1811693377
Provider Name (Legal Business Name): KENIA A RIJO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 LEXINGTON AVE APT 9D
NEW YORK NY
10035-2913
US

IV. Provider business mailing address

45 CROSS RD
STAMFORD CT
06905-3403
US

V. Phone/Fax

Practice location:
  • Phone: 646-591-1345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: