Provider Demographics
NPI:1205602588
Name:JONES, KENNETH SHAH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:SHAH
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MAIN ST APT 511
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-7087
Mailing Address - Country:US
Mailing Address - Phone:646-706-8479
Mailing Address - Fax:
Practice Address - Street 1:66 MAIN ST APT 511
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-7087
Practice Address - Country:US
Practice Address - Phone:646-706-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)