Provider Demographics
NPI:1528386679
Name:BROFMAN, JERELYN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERELYN
Middle Name:J
Last Name:BROFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 84TH ST
Mailing Address - Street 2:APT. 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6268
Mailing Address - Country:US
Mailing Address - Phone:212-772-2710
Mailing Address - Fax:212-472-0877
Practice Address - Street 1:401 E 84TH ST
Practice Address - Street 2:APT. 4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-6268
Practice Address - Country:US
Practice Address - Phone:212-772-2710
Practice Address - Fax:212-472-0877
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06894-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical