Provider Demographics
NPI:1083376677
Name:OQUENDO, ROBIN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:OQUENDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 ALBION PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1820
Mailing Address - Country:US
Mailing Address - Phone:646-515-7571
Mailing Address - Fax:
Practice Address - Street 1:568 BAY ST STE 10
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3895
Practice Address - Country:US
Practice Address - Phone:347-881-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03366938Medicaid