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NPI Code Detail

MEDICARE: KEITH M JONAS LCSW-R

MEDICARE: KEITH M JONAS LCSW-R
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
11041C0700XClinical Social WorkerR052519-1NY

General Provider Information

NPI Number : 1356425813
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH M JONAS LCSW-R
Provider Business Mailing Address
First Line : 13703 257TH ST
Second Line :
City : ROSEDALE
State : NY
Zip : 11422-3326
Country : US
Telephone Number : 718-527-5362
Fax Number :
Provider Business Practice Location Address
First Line : 6355 BROADWAY
Second Line :
City : BRONX
State : NY
Zip : 10471-2701
Country : US
Telephone Number : 718-796-4424
Fax Number : 718-796-4138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 07/08/2007

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