Provider Demographics
NPI:1053726679
Name:PARISI, JACKIE
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:PARISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MAIN ST
Mailing Address - Street 2:APT A
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4475
Mailing Address - Country:US
Mailing Address - Phone:845-863-7696
Mailing Address - Fax:
Practice Address - Street 1:112 MAIN ST
Practice Address - Street 2:APT A
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4475
Practice Address - Country:US
Practice Address - Phone:845-863-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72079331104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker