Basic Information
| Provider Information | |||||||||
| NPI: | 1093035214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SURIEL | ||||||||
| FirstName: | JELEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 EMMONS AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112352209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183686291 | ||||||||
| FaxNumber: | 7183686290 | ||||||||
| Practice Location | |||||||||
| Address1: | 865 E 4TH ST | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4842219136 | ||||||||
| FaxNumber: | 4842219130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 06/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.