MEDICARE: MR. GILES JUNUIS FERRELL II MHC-LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P108891	NY

General Provider Information

NPI Number	:	1598341901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GILES JUNUIS FERRELL II MHC-LP

Provider Business Mailing Address
First Line	:	210 JORALEMON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3743
Country	:	US
Telephone Number	:	347-799-1877
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 JORALEMON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3743
Country	:	US
Telephone Number	:	347-799-1877
Fax Number	:	347-529-4652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/24/2021

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