Basic Information
| Provider Information | |||||||||
| NPI: | 1780094193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNT | ||||||||
| FirstName: | JACQUELYN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2581 ATLANTIC AVE | ||||||||
| Address2: | HIGHLAND PARK CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112072412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184956700 | ||||||||
| FaxNumber: | 7184854018 | ||||||||
| Practice Location | |||||||||
| Address1: | 2384 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112333402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182726074 | ||||||||
| FaxNumber: | 7189227362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2014 | ||||||||
| LastUpdateDate: | 06/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 0907321 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.