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General NPI Number Information
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NPI Number | 1972245512
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Entity Type | Individual
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Provider Name | MR. JEZEBEL ERAZO
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Gender | Female
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 672 PARKSIDE AVE FL 2
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City | BROOKLYN
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State | NY
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Zip | 11226-2298
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Country | US
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Telephone | 718-246-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 BRIGHAM ST FL 2
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City | BROOKLYN
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State | NY
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Zip | 11229-5511
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Country | US
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Telephone | 347-587-9561
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 112076
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License Number State | NY
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