Provider Demographics
NPI:1720359292
Name:MAGALLANES, JARRON (BCD, LCSW, ACSW)
Entity Type:Individual
Prefix:MR
First Name:JARRON
Middle Name:
Last Name:MAGALLANES
Suffix:
Gender:M
Credentials:BCD, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BROADWAY FL 5
Mailing Address - Street 2:523
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4709
Mailing Address - Country:US
Mailing Address - Phone:917-239-6149
Mailing Address - Fax:
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:5TH FLOOR SUITE 523
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4709
Practice Address - Country:US
Practice Address - Phone:917-239-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0809371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical