Individual
KERNISHA OTWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
694 BEACH 20TH ST, FAR ROCKAWAY, NY 11691-3502
(718) 945-2273
Mailing address
1347 FULTON ST, BROOKLYN, NY 11216-5223
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/16/2022
Last updated
03/12/2025
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