Provider Demographics
NPI:1649934605
Name:TOLENTINO, EDWIN (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 MORRIS GATE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2432
Mailing Address - Country:US
Mailing Address - Phone:917-806-5124
Mailing Address - Fax:
Practice Address - Street 1:1972 MORRIS GATE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2432
Practice Address - Country:US
Practice Address - Phone:917-806-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1183526103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool