Healthcare Provider Details

I. General information

NPI: 1487328175
Provider Name (Legal Business Name): LOUISE EMANUEL LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17022 130TH AVE APT 11H
JAMAICA NY
11434-3237
US

IV. Provider business mailing address

17022 130TH AVE APT 11H
JAMAICA NY
11434-3237
US

V. Phone/Fax

Practice location:
  • Phone: 347-553-8949
  • Fax:
Mailing address:
  • Phone: 347-553-8949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOUISE EMANUEL
Title or Position: OWNER/CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 347-553-8949