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General NPI Number Information
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NPI Number | 1619227253
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Entity Type | Organization
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Legal Business Name | KEW GARDENS CENTER FOR WELLNESS
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 11929 80TH RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1105
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Country | US
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Telephone | 718-261-5728
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Fax | 718-261-5734
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Provider Business Mailing Address
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Address Line | 11929 80TH RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1105
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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 | PARTNER/OWNER
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Name | MS. JEANNE A FRIEDMAN
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Credential | LCSW
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Telephone | 347-200-7729
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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 | 070670
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License Number State | NY
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