Provider Demographics
NPI:1407653918
Name:SOTELO-DYNEGA PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:SOTELO-DYNEGA PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/MEMBER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTELO-DYNEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:347-610-1036
Mailing Address - Street 1:70 GLEN COVE RD STE LL4
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1722
Mailing Address - Country:US
Mailing Address - Phone:347-610-1036
Mailing Address - Fax:
Practice Address - Street 1:70 GLEN COVE RD STE LL4
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1722
Practice Address - Country:US
Practice Address - Phone:347-610-1036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health