Individual
MISS CHERYL BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRC
Contact information
Practice address
8268 164TH ST, JAMAICA, NY 11432-1121
(718) 883-3225
(718) 883-6193
Mailing address
7901 BROADWAY, MANAGED CARE, D1-01, ELMHURST, NY 11373-1329
(718) 334-1921
(718) 334-3432
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11761
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00246075
—
NY
Enumeration date
04/03/2007
Last updated
07/08/2007
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