Provider Demographics
NPI:1376956458
Name:BORER, JEREMY (LCSW)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BORER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2804
Mailing Address - Country:US
Mailing Address - Phone:917-328-1193
Mailing Address - Fax:
Practice Address - Street 1:32 COURT ST STE 1901
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4421
Practice Address - Country:US
Practice Address - Phone:917-328-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0811791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical