Provider Demographics
NPI:1376851253
Name:POW, SHERESE ANTOINETTE (MSEDU)
Entity Type:Individual
Prefix:
First Name:SHERESE
Middle Name:ANTOINETTE
Last Name:POW
Suffix:
Gender:F
Credentials:MSEDU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101-2101A DAVIDSON AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:914-434-3434
Mailing Address - Fax:
Practice Address - Street 1:2101 DAVIDSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-3303
Practice Address - Country:US
Practice Address - Phone:914-434-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst