Healthcare Provider Details

I. General information

NPI: 1609598416
Provider Name (Legal Business Name): BRANDON JONES CM, COMM, LCSW,PRES,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: COMMISSIONER BRANDON JONES CM, PRESIDENT, COMM,

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E 125TH ST
NEW YORK NY
10035-1685
US

IV. Provider business mailing address

1075 WEBSTER AVE # 4B5
BRONX NY
10456-5931
US

V. Phone/Fax

Practice location:
  • Phone: 212-470-1465
  • Fax: 646-921-3189
Mailing address:
  • Phone: 212-470-1465
  • Fax: 646-921-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0001135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: