Provider Demographics
NPI:1972245512
Name:ERAZO, JEZEBEL
Entity Type:Individual
Prefix:MR
First Name:JEZEBEL
Middle Name:
Last Name:ERAZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 BRIGHAM ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5511
Mailing Address - Country:US
Mailing Address - Phone:347-587-9561
Mailing Address - Fax:
Practice Address - Street 1:672 PARKSIDE AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2298
Practice Address - Country:US
Practice Address - Phone:718-246-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112076104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker