=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801191457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENIO ALEJANDRO DUARTE PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2011
-----------------------------------------------------
Last Update Date | 01/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 96 5TH AVE SUITE 1K
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-7605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-727-9214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 W 50TH ST APT. 5C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-7191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-494-2616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 018729
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------