Provider Demographics
NPI:1609140482
Name:PREVAL, JOE (LMHC)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:PREVAL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:PREVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SCHOOL PSYCHOLOGIST
Mailing Address - Street 1:1636 LEXINGTON AVE
Mailing Address - Street 2:APT. 18
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5330
Mailing Address - Country:US
Mailing Address - Phone:917-355-3564
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1410
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6674
Practice Address - Country:US
Practice Address - Phone:347-460-6570
Practice Address - Fax:212-889-8764
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health