Healthcare Provider Details

I. General information

NPI: 1962637173
Provider Name (Legal Business Name): ABIGAIL RIVERA KUO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 98TH ST APT.5BS
NEW YORK NY
10025-5500
US

IV. Provider business mailing address

305 W 98TH ST APT.5BS
NEW YORK NY
10025-5500
US

V. Phone/Fax

Practice location:
  • Phone: 212-678-4507
  • Fax: 212-749-5967
Mailing address:
  • Phone: 212-678-4507
  • Fax: 212-749-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070117-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: