Provider Demographics
NPI:1700083995
Name:JAUREGUI, JOHN A (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:JAUREGUI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 STERLING PL
Mailing Address - Street 2:APT. 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4826
Mailing Address - Country:US
Mailing Address - Phone:917-626-3871
Mailing Address - Fax:
Practice Address - Street 1:7410 35TH AVE
Practice Address - Street 2:STE 107W
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8197
Practice Address - Country:US
Practice Address - Phone:917-626-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist