Provider Demographics
NPI:1225767999
Name:ROUNDTREE, JABORN CARLIE (MHC)
Entity Type:Individual
Prefix:MS
First Name:JABORN
Middle Name:CARLIE
Last Name:ROUNDTREE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326 68TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3200
Mailing Address - Country:US
Mailing Address - Phone:718-261-3330
Mailing Address - Fax:
Practice Address - Street 1:10326 68TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3200
Practice Address - Country:US
Practice Address - Phone:718-261-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP115304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health