Provider Demographics
NPI:1013437045
Name:JONES, DAVID (CASAC 2)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:CASAC 2
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:CASAC 2
Mailing Address - Street 1:11136 196TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2027
Mailing Address - Country:US
Mailing Address - Phone:184-645-9047
Mailing Address - Fax:
Practice Address - Street 1:11630 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1527
Practice Address - Country:US
Practice Address - Phone:183-222-5007
Practice Address - Fax:718-322-1881
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11786101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)