Provider Demographics
NPI:1336554732
Name:KERSON, NAKIMA
Entity Type:Individual
Prefix:
First Name:NAKIMA
Middle Name:
Last Name:KERSON
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 1:95-117 RAVINE AVE # 13-3A
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2165
Mailing Address - Country:US
Mailing Address - Phone:917-698-0932
Mailing Address - Fax:
Practice Address - Street 1:95-117 RAVINE AVE # 13-3A
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2165
Practice Address - Country:US
Practice Address - Phone:917-698-0932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0896021104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker