Basic Information
| Provider Information | |||||||||
| NPI: | 1295397115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOICO | ||||||||
| FirstName: | ABENAMAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 W 15TH ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100116701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129246320 | ||||||||
| FaxNumber: | 6463060513 | ||||||||
| Practice Location | |||||||||
| Address1: | 4123 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104576222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182993045 | ||||||||
| FaxNumber: | 6465659491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2019 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041S0200X | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.