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General NPI Number Information
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NPI Number | 1396525663
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Entity Type | Individual
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Provider Name | JACQUELYN TAYLOR CLASS LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 928 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10010-6008
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Country | US
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Telephone | 908-875-5451
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Fax |
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Provider Business Mailing Address
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Address Line | 147 ELM ST APT 1
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City | KEARNY
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State | NJ
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Zip | 07032-3483
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL06970100
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License Number State | NJ
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