Provider Demographics
NPI:1710617014
Name:NACHAJON, IAEL
Entity Type:Individual
Prefix:
First Name:IAEL
Middle Name:
Last Name:NACHAJON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YAEL
Other - Middle Name:
Other - Last Name:NACHAJON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:836 BERGEN ST APT 204
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-7455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:836 BERGEN ST APT 204
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-7455
Practice Address - Country:US
Practice Address - Phone:201-693-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116455104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker