Healthcare Provider Details

I. General information

NPI: 1366740789
Provider Name (Legal Business Name): JANET-MICHELLE MAE CUEVAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WHITE PLAINS ROAD SUITE 500 (FIFTH FLOOR)
TARRYTOWN NY
10591-5118
US

IV. Provider business mailing address

264 WOODLANDS DR
TUXEDO PARK NY
10987-4818
US

V. Phone/Fax

Practice location:
  • Phone: 917-744-0607
  • Fax: 914-467-7801
Mailing address:
  • Phone: 917-744-0607
  • Fax: 914-467-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083410
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083344-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: