Healthcare Provider Details

I. General information

NPI: 1407640030
Provider Name (Legal Business Name): JUSTICE WILFREDO BATISTA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date: 11/07/2025
Reactivation Date: 09/28/2026

III. Provider practice location address

147 LAKE ST
NEWBURGH NY
12550-5263
US

IV. Provider business mailing address

2570 ROUTE 9W STE 10
CORNWALL NY
12518-1370
US

V. Phone/Fax

Practice location:
  • Phone: 845-563-8000
  • Fax: 845-565-1364
Mailing address:
  • Phone: 845-220-3100
  • Fax: 845-534-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: