Provider Demographics
NPI:1417089012
Name:KUMAGAY, MARIA (LCSW, CGP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KUMAGAY
Suffix:
Gender:F
Credentials:LCSW, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 GRAND CONCOURSE
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4304
Mailing Address - Country:US
Mailing Address - Phone:718-960-3072
Mailing Address - Fax:718-583-4080
Practice Address - Street 1:2021 GRAND CONCOURSE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4304
Practice Address - Country:US
Practice Address - Phone:718-960-3072
Practice Address - Fax:718-583-4080
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055507-1104100000X
NY0772031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker