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General NPI Number Information
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NPI Number | 1801430145
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Entity Type | Individual
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Provider Name | JESSE TRUXTON LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 11247 QUEENS BLVD STE 104
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City | FOREST HILLS
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State | NY
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Zip | 11375-7418
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Country | US
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Telephone | 347-391-4205
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Fax |
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Provider Business Mailing Address
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Address Line | 7732 VLEIGH PL APT B
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City | FLUSHING
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State | NY
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Zip | 11367-3146
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 113802
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License Number State | NY
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Taxonomy #2
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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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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 100719
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License Number State | NY
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