Individual
TIMOTHY E JERVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC-T CRPA-P
Contact information
Practice address
20 SICKLES AVE, NEW ROCHELLE, NY 10801-4030
(914) 613-0700
(914) 355-5425
Mailing address
14 AMSTERDAM PL APT 4A, MOUNT VERNON, NY 10553-1474
(646) 271-3281
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
32080
NY
Other
Enumeration date
02/06/2020
Last updated
02/06/2020
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