Healthcare Provider Details

I. General information

NPI: 1891334538
Provider Name (Legal Business Name): IRIS HAREL MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2019
Last Update Date: 12/28/2019
Certification Date: 12/28/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14138 71ST RD
FLUSHING NY
11367-1945
US

IV. Provider business mailing address

14138 71ST RD
FLUSHING NY
11367-1945
US

V. Phone/Fax

Practice location:
  • Phone: 917-306-8115
  • Fax:
Mailing address:
  • Phone: 917-306-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00895
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number043B
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: