Healthcare Provider Details

I. General information

NPI: 1578951760
Provider Name (Legal Business Name): JESSICA HERD M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TILDEN ST
BRONX NY
10467-6013
US

IV. Provider business mailing address

28 PACER DR
NEWBURGH NY
12550-3838
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18007752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: