Healthcare Provider Details

I. General information

NPI: 1831676519
Provider Name (Legal Business Name): JOANNA BERMUDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 FRISBY AVE
BRONX NY
10461-3240
US

IV. Provider business mailing address

495 ODELL AVE APT 5B
YONKERS NY
10703-1139
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-1610
  • Fax:
Mailing address:
  • Phone: 914-510-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011524
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP11889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: