Provider Demographics
NPI:1992457303
Name:QUINTERO, ROGER ORLANDO (MS)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ORLANDO
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W LAKELAND ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2621
Mailing Address - Country:US
Mailing Address - Phone:631-889-5185
Mailing Address - Fax:
Practice Address - Street 1:FAMILY OF KIDZ
Practice Address - Street 2:2341 NEW HYDE PARK RD.
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-806-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-21-55833103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst