| Compadre Therapy Lcsw Pllc | |
|
2447 Saint Raymonds Ave Bronx NY 10461-3162 | |
| (929) 266-7204 | |
| (347) 897-6388 |
| Full Name | Compadre Therapy Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2447 Saint Raymonds Ave, Bronx, New York |
| Authorized Official Name and Position | Marcelino Guillen (ADMINISTRATOR/PROVIDER) |
| Authorized Official Contact | 9292667204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Compadre Therapy Lcsw Pllc 2447 Saint Raymonds Ave Bronx NY 10461-3162 Ph: (929) 266-7204 | Compadre Therapy Lcsw Pllc 2447 Saint Raymonds Ave Bronx NY 10461-3162 Ph: (929) 266-7204 |
| NPI Number | 1245893569 |
|---|---|
| Provider Enumeration Date | 04/22/2019 |
| Last Update Date | 06/19/2022 |
| Certification Date | 06/19/2022 |
| Medicare PECOS PAC ID | 9830521962 |
|---|---|
| Medicare Enrollment ID | O20191112000622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245893569 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Marcelino Guillen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497254106 PECOS PAC ID: 5991068439 Enrollment ID: I20180413001169 |
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