Healthcare Provider Details

I. General information

NPI: 1891394458
Provider Name (Legal Business Name): CECILIA LOURDES ABADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SUSSEX ST
PORT JERVIS NY
12771-2430
US

IV. Provider business mailing address

1240 LAKES RD
MONROE NY
10950-4220
US

V. Phone/Fax

Practice location:
  • Phone: 845-856-6344
  • Fax:
Mailing address:
  • Phone: 845-839-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: