MEDICARE: DR. CLEOLENE EUGENIE JONES

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	1041C0700X	Clinical Social Worker	074177-1	NY

General Provider Information

NPI Number	:	1760847990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLEOLENE EUGENIE JONES

Provider Business Mailing Address
First Line	:	10912 169TH PL
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-2932
Country	:	US
Telephone Number	:	718-739-9046
Fax Number	:

Provider Business Practice Location Address
First Line	:	10912 169TH PL
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-2932
Country	:	US
Telephone Number	:	718-739-9046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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