Provider Demographics
NPI:1063873263
Name:NORTH BROOKLYN MARRIAGE AND FAMILY THERAPY
Entity type:Organization
Organization Name:NORTH BROOKLYN MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:AULL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:718-785-9718
Mailing Address - Street 1:315 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3735
Mailing Address - Country:US
Mailing Address - Phone:718-785-9718
Mailing Address - Fax:
Practice Address - Street 1:315 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3735
Practice Address - Country:US
Practice Address - Phone:718-785-9718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty