Provider Demographics
NPI:1811395833
Name:NEW FRONTERAS LICENSED CLINICAL SOCIAL WORK SERVICES, PLLC
Entity type:Organization
Organization Name:NEW FRONTERAS LICENSED CLINICAL SOCIAL WORK SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-R
Authorized Official - Phone:845-219-1638
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-0322
Mailing Address - Country:US
Mailing Address - Phone:845-219-1638
Mailing Address - Fax:
Practice Address - Street 1:15 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2924
Practice Address - Country:US
Practice Address - Phone:845-219-1638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076772251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health