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General NPI Number Information
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NPI Number | 1134650757
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Entity Type | Individual
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Provider Name | JEZEBEL WALTER LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 78 MAIN STREET FAMILY SERVICES OF WESTCHESTER - ECHO HILLS
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City | HASTINGS-ON-HUDSON
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State | NY
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Zip | 10706
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Country | US
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Telephone | 914-274-8334
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Fax |
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Provider Business Mailing Address
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Address Line | 346 HERITAGE HLS UNIT B
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City | SOMERS
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State | NY
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Zip | 10589-1738
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Country | US
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Telephone | 917-576-8877
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 054433
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License Number State | NY
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