MEDICARE: HAITIAN AMERICAN FAMILY OF LONG ISLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1356000475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAITIAN AMERICAN FAMILY OF LONG ISLAND

Provider Business Mailing Address
First Line	:	294 W MERRICK RD STE 7
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3357
Country	:	US
Telephone Number	:	516-628-9405
Fax Number	:

Provider Business Practice Location Address
First Line	:	294 W MERRICK RD STE 7
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3357
Country	:	US
Telephone Number	:	516-628-9405
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARYSE LAMERCIE EMMANUEL-GARCY
Credential	:	LMSW
Telephone Number	:	151-652-4672

Provider Enumeration Date	:	12/16/2021
Last Update Date	:	12/16/2021

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