Healthcare Provider Details

I. General information

NPI: 1801220736
Provider Name (Legal Business Name): MIRIAM PRAT JEREZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 CASTLETON AVENUE
STATEN ISLAND NY
10301
US

IV. Provider business mailing address

669 CASTLETON AVENUE.
STATEN ISLAND NY
10301
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-2225
  • Fax: 347-881-1616
Mailing address:
  • Phone: 347-627-2288
  • Fax: 347-881-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: