Provider Demographics
NPI:1275133803
Name:HYACINTHE, FORTUNA
Entity Type:Individual
Prefix:
First Name:FORTUNA
Middle Name:
Last Name:HYACINTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2317
Mailing Address - Country:US
Mailing Address - Phone:917-554-3779
Mailing Address - Fax:
Practice Address - Street 1:254 BENSON AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2317
Practice Address - Country:US
Practice Address - Phone:917-554-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst