Provider Demographics
NPI:1053800953
Name:HARLEY, AFIYA VENUS
Entity type:Individual
Prefix:
First Name:AFIYA
Middle Name:VENUS
Last Name:HARLEY
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 1:815 HENDRIX ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-7402
Mailing Address - Country:US
Mailing Address - Phone:347-210-8494
Mailing Address - Fax:
Practice Address - Street 1:50 NEVINS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1004
Practice Address - Country:US
Practice Address - Phone:718-855-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health