Provider Demographics
NPI:1053857995
Name:HERSCHENFELD, DARA
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:HERSCHENFELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 72ND ST
Mailing Address - Street 2:APT 7J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 E 72ND ST
Practice Address - Street 2:APT 7J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4537
Practice Address - Country:US
Practice Address - Phone:917-733-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1399659101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor