=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477094738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J HERSH COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2017
-----------------------------------------------------
Last Update Date | 03/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 949 CENTRAL AVE
-----------------------------------------------------
City | WOODMERE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11598-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-455-5305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 949 CENTRAL AVE
-----------------------------------------------------
City | WOODMERE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11598-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-455-5305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNIFER R HERSH-ZURNDORFER
-----------------------------------------------------
Credential | AUD
-----------------------------------------------------
Telephone | 516-455-5305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0808951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------