Provider Demographics
NPI:1003693268
Name:OVALLES, KENT
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:OVALLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HALSTEAD AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-4130
Mailing Address - Country:US
Mailing Address - Phone:347-609-8736
Mailing Address - Fax:
Practice Address - Street 1:84 HALSTEAD AVE APT 1B
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-4130
Practice Address - Country:US
Practice Address - Phone:347-609-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor