Individual
CJ MENA II
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35 DOCK ST, YONKERS, NY 10701-2733
(914) 965-1106
(914) 965-9705
Mailing address
35 DOCK ST, YONKERS, NY 10701-2733
(914) 965-1106
(914) 965-9705
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285628552
BEHAVIORAL HEALTH UNLICENSED COUNSELOR
NY
Enumeration date
10/11/2016
Last updated
10/11/2016
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