Provider Demographics
NPI:1417685629
Name:MESSEROUX, JEAN-MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:JEAN-MARIE
Middle Name:
Last Name:MESSEROUX
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1762
Mailing Address - Country:US
Mailing Address - Phone:407-242-5929
Mailing Address - Fax:
Practice Address - Street 1:201 E 144TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5907
Practice Address - Country:US
Practice Address - Phone:407-242-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116655104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker