Healthcare Provider Details

I. General information

NPI: 1699057315
Provider Name (Legal Business Name): JACQUELINE M POWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 - 95 ST.
BROOKLYN NY
11209-1605
US

IV. Provider business mailing address

3306 AVENUE T
BROOKLYN NY
11234-4911
US

V. Phone/Fax

Practice location:
  • Phone: 718-680-9751
  • Fax: 718-680-7977
Mailing address:
  • Phone: 718-680-9751
  • Fax: 718-689-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074868-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: