MEDICARE: WHITNEY JANIQUE BAMBERG

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	:	1972225092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY JANIQUE BAMBERG

Provider Business Mailing Address
First Line	:	3500 PARK AVE APT 6M
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-4582
Country	:	US
Telephone Number	:	347-664-2583
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 3RD AVE STE 701
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-6342
Country	:	US
Telephone Number	:	929-613-1737
Fax Number	:

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

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	09/15/2022

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Directions to “ WHITNEY JANIQUE BAMBERG ” Practice Location

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