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General NPI Number Information
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NPI Number | 1720336290
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Entity Type | Individual
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Provider Name | ELSIE V JACQUES MSW
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Gender | Female
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 8866 MYRTLE AVE LITTLE WONDERS, INC.
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City | GLENDALE
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State | NY
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Zip | 11385-7857
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Country | US
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Telephone | 718-850-0040
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Fax | 718-850-4441
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Provider Business Mailing Address
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Address Line | 88-66 MYRTLE AVENUE LITTLE WONDERS, INC.
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City | GLENDALE
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State | NY
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Zip | 11385
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Country | US
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Telephone | 718-850-0040
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Fax | 718-850-4441
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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