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General NPI Number Information
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NPI Number | 1275970790
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Entity Type | Individual
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Provider Name | STACEY JACQUES SOCIAL WORKER
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Gender | Female
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 731 WHITE PLAINS RD
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City | BRONX
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State | NY
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Zip | 10473-2631
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Country | US
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Telephone | 718-589-8775
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Fax | 718-395-8353
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Provider Business Mailing Address
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Address Line | 16 E 16TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-3105
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Country | US
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Telephone | 718-589-8775
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Fax | 718-395-8353
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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 | 088404
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License Number State | NY
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