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General NPI Number Information
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NPI Number | 1154271682
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Entity Type | Individual
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Provider Name | ANNETTE JAQUEZ
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Gender | Female
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/07/2026
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Provider Practice Location Address
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Address Line | 4902 QUEENS BLVD
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City | WOODSIDE
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State | NY
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Zip | 11377-4444
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Country | US
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Telephone | 929-296-6790
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Fax | 929-300-0280
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Provider Business Mailing Address
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Address Line | 310 SAINT NICHOLAS AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-6566
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Country | US
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Telephone | 929-296-6790
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Fax | 929-300-0280
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Authorized Official
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Title or Position |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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