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General NPI Number Information
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NPI Number | 1962770420
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Entity Type | Organization
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Legal Business Name | NEW FRONTERAS MENTAL HEALTH COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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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 | 845-558-7387
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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 | 845-558-7387
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Fax | 845-215-5555
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Authorized Official
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Title or Position | MANAGER
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Name | DR. EDWARDO RODRIGUEZ
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Credential | PHD, LMHC
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Telephone | 845-558-7387
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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 |
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License Number State |
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