Provider Demographics
NPI:1104948462
Name:JARRATT, KENT DOUGLASS (LCSW)
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:DOUGLASS
Last Name:JARRATT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 AVENUE OF THE AMERICAS
Mailing Address - Street 2:SUITE 1705
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3507
Mailing Address - Country:US
Mailing Address - Phone:212-741-7744
Mailing Address - Fax:
Practice Address - Street 1:875 AVENUE OF THE AMERICAS
Practice Address - Street 2:SUITE 1705
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3507
Practice Address - Country:US
Practice Address - Phone:212-741-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036725-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN42601Medicare ID - Type UnspecifiedPROVIDER NUMBER