MEDICARE: ALYSSA JENKINS

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1609356203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA JENKINS

Provider Business Mailing Address
First Line	:	1180 HALSEY ST UNIT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-1207
Country	:	US
Telephone Number	:	610-368-9301
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 RICHARDSON ST FL 52
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-1306
Country	:	US
Telephone Number	:	347-687-6616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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