Healthcare Provider Details

I. General information

NPI: 1093646069
Provider Name (Legal Business Name): HERINA KOKO AYOT MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2976 NORTHERN BLVD # 277-F
LONG ISLAND CITY NY
11101-2822
US

IV. Provider business mailing address

2976 NORTHERN BLVD # 277-F
LONG ISLAND CITY NY
11101-2822
US

V. Phone/Fax

Practice location:
  • Phone: 929-630-1737
  • Fax: 929-630-1737
Mailing address:
  • Phone: 929-630-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P142678-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: