Provider Demographics
NPI:1528232121
Name:JOLLY, SURABHI
Entity Type:Individual
Prefix:MS
First Name:SURABHI
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 REMSEN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4300
Mailing Address - Country:US
Mailing Address - Phone:718-858-4050
Mailing Address - Fax:
Practice Address - Street 1:175 REMSEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4300
Practice Address - Country:US
Practice Address - Phone:718-858-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical