Healthcare Provider Details

I. General information

NPI: 1043948953
Provider Name (Legal Business Name): MS. CHERISE MIZELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14819 90TH AVE APT 8G
JAMAICA NY
11435-4076
US

IV. Provider business mailing address

14819 90TH AVE APT 8G
JAMAICA NY
11435-4076
US

V. Phone/Fax

Practice location:
  • Phone: 347-596-9496
  • Fax:
Mailing address:
  • Phone: 347-596-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: