Provider Demographics
NPI:1326102575
Name:URENO, SERGIO ROMAN (PH D)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:ROMAN
Last Name:URENO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5800 3RD AVE
Mailing Address - Street 2:MANAGED CARE DEPARTMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3702
Mailing Address - Country:US
Mailing Address - Phone:718-630-7477
Mailing Address - Fax:718-630-7437
Practice Address - Street 1:514 49TH ST
Practice Address - Street 2:LUTHERAN FHC SUNSET TERRACE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2010
Practice Address - Country:US
Practice Address - Phone:718-854-1851
Practice Address - Fax:718-435-8510
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016031103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist