Provider Demographics
NPI:1316565252
Name:CONQUEST HEALTH & WELLNESS, LLC.
Entity Type:Organization
Organization Name:CONQUEST HEALTH & WELLNESS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-694-6304
Mailing Address - Street 1:1317 EDGEWATER DR # 875
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2015 SHANNON LAKES CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-3651
Practice Address - Country:US
Practice Address - Phone:407-694-6304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty