Healthcare Provider Details

I. General information

NPI: 1225730211
Provider Name (Legal Business Name): TUNISHA EADDY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9037 PARSONS BLVD
JAMAICA NY
11432-6032
US

IV. Provider business mailing address

9037 PARSONS BLVD
JAMAICA NY
11432-6032
US

V. Phone/Fax

Practice location:
  • Phone: 718-553-3809
  • Fax: 718-553-3851
Mailing address:
  • Phone: 718-553-3809
  • Fax: 718-553-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: