Provider Demographics
NPI:1710412333
Name:HENRIQUEZ, AMARANTA
Entity Type:Individual
Prefix:
First Name:AMARANTA
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 GERARD AVE APT 7P
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5375
Mailing Address - Country:US
Mailing Address - Phone:347-734-6000
Mailing Address - Fax:
Practice Address - Street 1:509 WILLIS AVE FL 4A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4001
Practice Address - Country:US
Practice Address - Phone:347-734-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health