Healthcare Provider Details

I. General information

NPI: 1538791223
Provider Name (Legal Business Name): PENELOPE ELISE BRABHAM-JONES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEHAVIORAL HEALTH SERVICES THE CHILDREN'S VILLAGE - ONE ECHO HILLS
DOBBS FERRY NY
10522
US

IV. Provider business mailing address

46 BIRCH BROOK RD
CORTLANDT MANOR NY
10567-7405
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-0600
  • Fax: 914-517-6886
Mailing address:
  • Phone: 914-851-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083338
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: