Provider Demographics
NPI:1407744147
Name:JEREZ, NIKOL
Entity type:Individual
Prefix:
First Name:NIKOL
Middle Name:
Last Name:JEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 MILLVALE AVE
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3541
Mailing Address - Country:US
Mailing Address - Phone:205-415-1730
Mailing Address - Fax:
Practice Address - Street 1:7 GWYNNS MILL CT STE I
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3528
Practice Address - Country:US
Practice Address - Phone:410-443-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician