Provider Demographics
NPI:1902394216
Name:EZRA SERVICES INC.
Entity Type:Organization
Organization Name:EZRA SERVICES INC.
Other - Org Name:EZRA FAMILY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-668-7159
Mailing Address - Street 1:3250 70TH ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1712
Mailing Address - Country:US
Mailing Address - Phone:347-668-7159
Mailing Address - Fax:
Practice Address - Street 1:3250 70TH ST APT 2G
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1712
Practice Address - Country:US
Practice Address - Phone:347-668-7159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty