Provider Demographics
NPI:1124591300
Name:JAIME, ESTHER J (WSP)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:J
Last Name:JAIME
Suffix:
Gender:F
Credentials:WSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2927
Mailing Address - Country:US
Mailing Address - Phone:718-859-4500
Mailing Address - Fax:
Practice Address - Street 1:384 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3908
Practice Address - Country:US
Practice Address - Phone:646-283-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWSPMedicaid