Healthcare Provider Details

I. General information

NPI: 1154870293
Provider Name (Legal Business Name): KEVIN JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S BROADWAY STE 402
YONKERS NY
10701-3723
US

IV. Provider business mailing address

20 S BROADWAY STE 402
YONKERS NY
10701-3723
US

V. Phone/Fax

Practice location:
  • Phone: 914-345-0700
  • Fax:
Mailing address:
  • Phone: 914-345-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009237
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: