Provider Demographics
NPI:1417248535
Name:JEREZ, ARLENE A (MS)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:A
Last Name:JEREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3204
Mailing Address - Country:US
Mailing Address - Phone:646-509-5595
Mailing Address - Fax:
Practice Address - Street 1:158 CHESTER ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3204
Practice Address - Country:US
Practice Address - Phone:646-509-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY496682111103K00000X
NY496681111103K00000X
496682111174400000X
NY1501792211103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist