Healthcare Provider Details

I. General information

NPI: 1619227253
Provider Name (Legal Business Name): KEW GARDENS CENTER FOR WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11929 80TH RD
KEW GARDENS NY
11415-1105
US

IV. Provider business mailing address

11929 80TH RD
KEW GARDENS NY
11415-1105
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-5728
  • Fax: 718-261-5734
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070670
License Number StateNY

VIII. Authorized Official

Name: MS. JEANNE A FRIEDMAN
Title or Position: PARTNER/OWNER
Credential: LCSW
Phone: 347-200-7729