Provider Demographics
NPI:1184344723
Name:FARRO FUENTES, ENEIDA J (LMSW)
Entity type:Individual
Prefix:
First Name:ENEIDA
Middle Name:J
Last Name:FARRO FUENTES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOUSTON PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2811
Mailing Address - Country:US
Mailing Address - Phone:347-281-3430
Mailing Address - Fax:
Practice Address - Street 1:10320 CORONA AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11368-3179
Practice Address - Country:US
Practice Address - Phone:845-520-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113095104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty