Provider Demographics
NPI:1811572613
Name:JAIN, PRARTHITA (MHC-LP)
Entity type:Individual
Prefix:
First Name:PRARTHITA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
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 1:50 W 34TH ST APT 16B1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3086
Mailing Address - Country:US
Mailing Address - Phone:929-319-3320
Mailing Address - Fax:
Practice Address - Street 1:1979 MARCUS AVE STE 210
Practice Address - Street 2:
Practice Address - City:NORTH NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1022
Practice Address - Country:US
Practice Address - Phone:646-384-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP106350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty