Provider Demographics
NPI:1033305982
Name:OVIEDO, LUZ MARIEL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LUZ
Middle Name:MARIEL
Last Name:OVIEDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 METROPOLITAN AVE STE 2F
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2636
Mailing Address - Country:US
Mailing Address - Phone:917-773-7637
Mailing Address - Fax:
Practice Address - Street 1:7405 METROPOLITAN AVE STE 2F
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2636
Practice Address - Country:US
Practice Address - Phone:917-773-7637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075276-1104100000X
NY0792831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245029Medicaid