Provider Demographics
NPI:1821553678
Name:ALLOMOTHERING NY CHAPTER
Entity Type:Organization
Organization Name:ALLOMOTHERING NY CHAPTER
Other - Org Name:ALLOMOTHERING NY CHAPTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:347-788-0193
Mailing Address - Street 1:84 MARION ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2103
Mailing Address - Country:US
Mailing Address - Phone:347-788-0193
Mailing Address - Fax:
Practice Address - Street 1:84 MARION ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-2103
Practice Address - Country:US
Practice Address - Phone:347-788-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health