Provider Demographics
NPI:1548595804
Name:DEYO, JACQUELINE KATE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:KATE
Last Name:DEYO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CENTRAL PARK W
Mailing Address - Street 2:APT 10D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5204
Mailing Address - Country:US
Mailing Address - Phone:973-652-3559
Mailing Address - Fax:
Practice Address - Street 1:16515 88TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4113
Practice Address - Country:US
Practice Address - Phone:718-291-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker