Basic Information
| Provider Information | |||||||||
| NPI: | 1922440064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYOR | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | CARLOS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9121 71ST AVE | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113756704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176752462 | ||||||||
| FaxNumber: | 7188970095 | ||||||||
| Practice Location | |||||||||
| Address1: | 10326 68TH RD | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182613330 | ||||||||
| FaxNumber: | 7188970095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 05/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 094661-1 | NY | N | Other Service Providers | Specialist | 1041C0700X | 094661-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.