Healthcare Provider Details

I. General information

NPI: 1740117787
Provider Name (Legal Business Name): ELISA CECILIA BARGUIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9740 62ND DR APT 14E
REGO PARK NY
11374-1327
US

IV. Provider business mailing address

9740 62ND DR APT 14E
REGO PARK NY
11374-1327
US

V. Phone/Fax

Practice location:
  • Phone: 347-324-6994
  • Fax: 347-324-6994
Mailing address:
  • Phone: 347-324-6994
  • Fax: 347-324-6994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: