Healthcare Provider Details

I. General information

NPI: 1336870815
Provider Name (Legal Business Name): JAYNE GONEZE SEMEXANT UDE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 11/17/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 PARK AVE
NEW YORK NY
10029-3810
US

IV. Provider business mailing address

7525 153RD ST APT 234
KEW GARDENS HILLS NY
11367-3099
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax:
Mailing address:
  • Phone: 781-636-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: