Provider Demographics
NPI:1164124293
Name:JEREZ SANCHEZ, MASSIEL
Entity Type:Individual
Prefix:
First Name:MASSIEL
Middle Name:
Last Name:JEREZ SANCHEZ
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 1:2305 SEDGWICK AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5757
Mailing Address - Country:US
Mailing Address - Phone:192-921-7636
Mailing Address - Fax:
Practice Address - Street 1:1 ECHO HL
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3600
Practice Address - Country:US
Practice Address - Phone:914-693-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116972104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker