Healthcare Provider Details

I. General information

NPI: 1467132175
Provider Name (Legal Business Name): JACQUELINE ADAMSON BEDNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 DOBBIN ST STE 204A
BROOKLYN NY
11222-2803
US

IV. Provider business mailing address

117 DOBBIN ST STE 204A
BROOKLYN NY
11222-2803
US

V. Phone/Fax

Practice location:
  • Phone: 347-255-1747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P123081-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: