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NPI Code Detail

MEDICARE: JACQUELINE FILIS LCSW, CASAC

MEDICARE: JACQUELINE FILIS LCSW, CASAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker077950-1NY

General Provider Information

NPI Number : 1194093757
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE FILIS LCSW, CASAC
Provider Business Mailing Address
First Line : 146 BARTOW AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-3226
Country : US
Telephone Number : 917-359-6287
Fax Number :
Provider Business Practice Location Address
First Line : 3911 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-5110
Country : US
Telephone Number : 718-948-3232
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2011
Last Update Date : 01/19/2021

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