Provider Demographics
NPI:1801191457
Name:DUARTE, EUGENIO ALEJANDRO (PHD)
Entity Type:Individual
Prefix:
First Name:EUGENIO
Middle Name:ALEJANDRO
Last Name:DUARTE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W 50TH ST
Mailing Address - Street 2:APT. 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7191
Mailing Address - Country:US
Mailing Address - Phone:305-494-2616
Mailing Address - Fax:
Practice Address - Street 1:96 5TH AVE
Practice Address - Street 2:SUITE 1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7605
Practice Address - Country:US
Practice Address - Phone:917-727-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical