Basic Information
Provider Information
NPI: 1033557954
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERRE-LOUISW
FirstName: ROSE-MAI
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: PIERRE-LOUIS MICHEL
OtherFirstName: ROSE-MAI
OtherMiddleName: J.
OtherNamePrefix: MRS.
OtherNameSuffix:  
OtherCredential: SOCIAL WORK
OtherLastNameType: 2
Mailing Information
Address1: 164 LOCUSTWOOD BLVD
Address2:  
City: ELMONT
State: NY
PostalCode: 110032009
CountryCode: US
TelephoneNumber: 5164249172
FaxNumber:  
Practice Location
Address1: 164 LOCUSTWOOD BLVD
Address2:  
City: ELMONT
State: NY
PostalCode: 110032009
CountryCode: US
TelephoneNumber: 5164249172
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/13/2013
LastUpdateDate: 06/13/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  Y Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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