Healthcare Provider Details

I. General information

NPI: 1982711669
Provider Name (Legal Business Name): JESSICA ELIZABETH BARRERA-MORALES LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6714 41ST AVE
WOODSIDE NY
11377-8128
US

IV. Provider business mailing address

6714 41ST AVE
WOODSIDE NY
11377-8128
US

V. Phone/Fax

Practice location:
  • Phone: 718-458-4243
  • Fax:
Mailing address:
  • Phone: 718-458-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070157-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: