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General NPI Number Information
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NPI Number | 1063873263
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Entity Type | Organization
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Legal Business Name | NORTH BROOKLYN MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 315 GRAHAM AVE
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City | BROOKLYN
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State | NY
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Zip | 11211-3735
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Country | US
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Telephone | 718-785-9718
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Fax |
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Provider Business Mailing Address
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Address Line | 315 GRAHAM AVE
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City | BROOKLYN
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State | NY
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Zip | 11211-3735
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Country | US
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Telephone | 718-785-9718
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER AULL
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Credential | LMFT
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Telephone | 718-785-9718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1091
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License Number State | NY
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