Individual
MR. LUIS R FAGUNDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
462 1ST AVE, NEW YORK, NY 10016-9196
(212) 562-4679
Mailing address
248 W 108TH ST, NEW YORK, NY 10025-2956
(212) 562-4679
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
078325
NY
Other
Enumeration date
03/17/2011
Last updated
09/20/2018
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