Provider Demographics
NPI:1750876769
Name:HORRY, IASISHA QUEMELOR (MA)
Entity type:Individual
Prefix:
First Name:IASISHA
Middle Name:QUEMELOR
Last Name:HORRY
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 W 143RD ST APT 43
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6023
Mailing Address - Country:US
Mailing Address - Phone:917-213-0604
Mailing Address - Fax:
Practice Address - Street 1:590 6TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2022
Practice Address - Country:US
Practice Address - Phone:212-633-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY123456104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health