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General NPI Number Information
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NPI Number | 1306329503
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Entity Type | Individual
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Provider Name | EVELYN AQUINO PAGE LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 2704 GRAND AVE STE 9
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City | BELLMORE
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State | NY
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Zip | 11710-3599
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Country | US
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Telephone | 908-346-7104
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Fax |
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Provider Business Mailing Address
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Address Line | 428 HARBOR RD UNIT B
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City | COLD SPRING HARBOR
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State | NY
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Zip | 11724-2100
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Country | US
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Telephone | 908-346-7104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 085737
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License Number State | NY
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