Provider Demographics
NPI:1801220736
Name:PRAT JEREZ, MIRIAM (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:PRAT JEREZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 CASTLETON AVENUE.
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301
Mailing Address - Country:US
Mailing Address - Phone:347-627-2288
Mailing Address - Fax:347-881-1616
Practice Address - Street 1:669 CASTLETON AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301
Practice Address - Country:US
Practice Address - Phone:718-442-2225
Practice Address - Fax:347-881-1616
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health