Healthcare Provider Details

I. General information

NPI: 1033044136
Provider Name (Legal Business Name): JENNIFER KAVITA HERALALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 16TH ST UNIT 3
BROOKLYN NY
11215-5607
US

IV. Provider business mailing address

395 16TH ST UNIT 3
BROOKLYN NY
11215-5607
US

V. Phone/Fax

Practice location:
  • Phone: 917-397-6760
  • Fax:
Mailing address:
  • Phone: 917-397-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP143539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: