Provider Demographics
NPI:1427708320
Name:SOLIS-FEARON, ZANIYAH KAILANII (PSYCHOTHERAPY)
Entity type:Individual
Prefix:DR
First Name:ZANIYAH
Middle Name:KAILANII
Last Name:SOLIS-FEARON
Suffix:
Gender:M
Credentials:PSYCHOTHERAPY
Other - Prefix:DR
Other - First Name:KAILANII
Other - Middle Name:
Other - Last Name:SOLIS-FEARON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:520 W 56TH ST APT 13K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3539
Mailing Address - Country:US
Mailing Address - Phone:201-606-3005
Mailing Address - Fax:
Practice Address - Street 1:520 W 56TH ST APT 13K
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10019-3539
Practice Address - Country:US
Practice Address - Phone:201-606-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X, 374K00000X, 103TP2701X
103TB0200X, 1041C0700X, 171400000X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY742335348-00Medicaid