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1790317956
TIMOTHY E JERVIS
NEW ROCHELLE, NY
NPI
1790317956
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NY 32080)
Enumeration Date
2020-02-06
Last Update Date
2020-02-06
Business Address
TIMOTHY E JERVIS CASAC-T CRPA-P
20 SICKLES AVE
NEW ROCHELLE, NY 10801-4030
Phone number: 914-613-0700
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Mailing Address
TIMOTHY E JERVIS CASAC-T CRPA-P
14 AMSTERDAM PL APT 4A
MOUNT VERNON, NY 10553-1474
Phone number: 646-271-3281
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