Healthcare Provider Details

I. General information

NPI: 1750261947
Provider Name (Legal Business Name): JEANETTE TOLEDO CRPA-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

IV. Provider business mailing address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

V. Phone/Fax

Practice location:
  • Phone: 929-273-7601
  • Fax:
Mailing address:
  • Phone: 929-273-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNYCPS-2977
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCRPA-P-9203
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberCRPA-P-9203
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberCRPA-P-9203
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCRPA-P-9203
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCRPA-P-9203
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-P-9203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: