Healthcare Provider Details

I. General information

NPI: 1740559079
Provider Name (Legal Business Name): MS. AISHA MENARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E 17TH ST # 78
BROOKLYN NY
11229-1281
US

IV. Provider business mailing address

9118 85TH ST APT 2
WOODHAVEN NY
11421-2931
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-1200
  • Fax: 718-382-3358
Mailing address:
  • Phone: 917-568-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number080437-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: