Provider Demographics
NPI:1295545275
Name:JEANLOUIS, EMMANUELLE DAYANNE DAYANNE (LIMITED PERMIT)
Entity type:Individual
Prefix:
First Name:EMMANUELLE DAYANNE
Middle Name:DAYANNE
Last Name:JEANLOUIS
Suffix:
Gender:F
Credentials:LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CROWN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1313
Mailing Address - Country:US
Mailing Address - Phone:347-580-2967
Mailing Address - Fax:
Practice Address - Street 1:108 CROWN AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1313
Practice Address - Country:US
Practice Address - Phone:347-580-2967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty