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General NPI Number Information
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NPI Number | 1568777407
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Entity Type | Individual
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Provider Name | PHARA JEAN-BAPTISTE LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 8972 214TH ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2330
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Country | US
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Telephone | 718-306-4006
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Fax |
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Provider Business Mailing Address
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Address Line | 20611 HILLSIDE AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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