Provider Demographics
NPI:1295161412
Name:REED BOOTHE, JAMILLAH
Entity type:Individual
Prefix:
First Name:JAMILLAH
Middle Name:
Last Name:REED BOOTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMILLAH
Other - Middle Name:
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40 RECTOR ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1705
Mailing Address - Country:US
Mailing Address - Phone:212-385-3030
Mailing Address - Fax:
Practice Address - Street 1:4812 9TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2418
Practice Address - Country:US
Practice Address - Phone:718-436-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty