Healthcare Provider Details

I. General information

NPI: 1366365751
Provider Name (Legal Business Name): JADE TRINITY STEWART SOCIAL WORK STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 E 53RD ST
BROOKLYN NY
11203-4407
US

IV. Provider business mailing address

58 ANNELLO WAY
MIDDLETOWN CT
06457-7950
US

V. Phone/Fax

Practice location:
  • Phone: 959-282-2390
  • Fax:
Mailing address:
  • Phone: 959-282-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: