Provider Demographics
NPI:1376739516
Name:EALY, FLORENCE TERESA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:TERESA
Last Name:EALY
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 1:6002 QUEENS BLVD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4973
Mailing Address - Country:US
Mailing Address - Phone:718-943-3470
Mailing Address - Fax:718-651-7227
Practice Address - Street 1:11515 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1020
Practice Address - Country:US
Practice Address - Phone:718-943-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0757251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical