Provider Demographics
NPI:1578717633
Name:CROGUENNEC, TALIA EVA (MSED)
Entity Type:Individual
Prefix:MS
First Name:TALIA
Middle Name:EVA
Last Name:CROGUENNEC
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 CENTER BLVD
Mailing Address - Street 2:APT 1004
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5738
Mailing Address - Country:US
Mailing Address - Phone:917-319-3890
Mailing Address - Fax:
Practice Address - Street 1:25 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5468
Practice Address - Country:US
Practice Address - Phone:888-518-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst