Provider Demographics
NPI:1508671991
Name:DUROSEAU, JALAI EDDIE DANIEL (MHC-LP)
Entity type:Individual
Prefix:MR
First Name:JALAI
Middle Name:EDDIE DANIEL
Last Name:DUROSEAU
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 RIVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2839
Mailing Address - Country:US
Mailing Address - Phone:516-660-6896
Mailing Address - Fax:
Practice Address - Street 1:2015 SHORE PKWY APT 2C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6819
Practice Address - Country:US
Practice Address - Phone:609-836-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0923661041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical