Provider Demographics
NPI:1033347307
Name:AJAERO, HENRIETTA C (MSC, MPA)
Entity Type:Individual
Prefix:MS
First Name:HENRIETTA
Middle Name:C
Last Name:AJAERO
Suffix:
Gender:F
Credentials:MSC, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MAIN ST
Mailing Address - Street 2:#531
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0023
Mailing Address - Country:US
Mailing Address - Phone:347-266-2464
Mailing Address - Fax:
Practice Address - Street 1:625 MAIN ST
Practice Address - Street 2:#531
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0023
Practice Address - Country:US
Practice Address - Phone:347-266-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23294103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23294OtherEI NUMBER