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General NPI Number Information
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NPI Number | 1811395833
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Entity Type | Organization
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Legal Business Name | NEW FRONTERAS LICENSED CLINICAL SOCIAL WORK SERVICES, PLLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 15 LAWRENCE ST
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City | NYACK
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State | NY
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Zip | 10960-2924
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Country | US
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Telephone | 845-219-1638
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 322
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City | NANUET
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State | NY
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Zip | 10954-0322
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Country | US
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Telephone | 845-219-1638
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CLARA I RODRIGUEZ
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Credential | PHD, LCSW-R
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Telephone | 845-219-1638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 076772
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License Number State | NY
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