Provider Demographics
NPI:1194457036
Name:STRUMPH, JACQUELINE RACHEL (LMSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RACHEL
Last Name:STRUMPH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6519
Mailing Address - Country:US
Mailing Address - Phone:347-562-3870
Mailing Address - Fax:
Practice Address - Street 1:50 BAY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2511
Practice Address - Country:US
Practice Address - Phone:646-902-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111055-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty