Provider Demographics
NPI:1568232791
Name:ARIAS, JORGE MARTIN (MA)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:MARTIN
Last Name:ARIAS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 HOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-2293
Mailing Address - Country:US
Mailing Address - Phone:347-882-6423
Mailing Address - Fax:
Practice Address - Street 1:245 EASTON STATION RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-5947
Practice Address - Country:US
Practice Address - Phone:917-972-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling