Provider Demographics
NPI:1225427321
Name:ARCHBOLD, JESSMINA (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSMINA
Middle Name:
Last Name:ARCHBOLD
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 1:7050 AUSTIN ST STE 113
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4746
Mailing Address - Country:US
Mailing Address - Phone:347-445-0543
Mailing Address - Fax:
Practice Address - Street 1:7050 AUSTIN ST STE 113
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4746
Practice Address - Country:US
Practice Address - Phone:347-445-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094804104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker