Provider Demographics
NPI:1316668577
Name:HERRING, JEREMY ALEXANDER (MHC-LP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALEXANDER
Last Name:HERRING
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:41 KOSCIUSZKO ST APT 310
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4986
Mailing Address - Country:US
Mailing Address - Phone:919-641-1099
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3454
Practice Address - Country:US
Practice Address - Phone:646-397-5255
Practice Address - Fax:914-462-4476
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health