Provider Demographics
NPI:1508402850
Name:BERENT, JONATHAN ALAN
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ALAN
Last Name:BERENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WELWYN RD APT 3N
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3534
Mailing Address - Country:US
Mailing Address - Phone:516-647-7723
Mailing Address - Fax:516-487-7414
Practice Address - Street 1:13 WELWYN RD APT 3N
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3534
Practice Address - Country:US
Practice Address - Phone:516-647-7723
Practice Address - Fax:516-487-7414
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR017604-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical