Provider Demographics
NPI:1720336290
Name:JACQUES, ELSIE V (MSW)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:V
Last Name:JACQUES
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 1:88-66 MYRTLE AVENUE
Mailing Address - Street 2:LITTLE WONDERS, INC.
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-850-0040
Mailing Address - Fax:718-850-4441
Practice Address - Street 1:8866 MYRTLE AVE
Practice Address - Street 2:LITTLE WONDERS, INC.
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7857
Practice Address - Country:US
Practice Address - Phone:718-850-0040
Practice Address - Fax:718-850-4441
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator