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NPI Code Detail

MEDICARE: MS. JESSICA J HERAS

MEDICARE: MS. JESSICA J HERAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1577757221NY

General Provider Information

NPI Number : 1336665793
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA J HERAS
Provider Business Mailing Address
First Line : 119 SCHENECTADY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-2330
Country : US
Telephone Number : 646-234-3447
Fax Number :
Provider Business Practice Location Address
First Line : 119 SCHENECTADY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-2330
Country : US
Telephone Number : 646-234-3447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2017
Last Update Date : 05/31/2022

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