| Legacy League Family Wellness Llc | |
|
14215 110th Ave Jamaica NY 11435-5624 | |
| (917) 923-5341 | |
| Not Available |
| Full Name | Legacy League Family Wellness Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 14215 110th Ave, Jamaica, New York |
| Authorized Official Name and Position | Twila Evanson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9179235341 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy League Family Wellness Llc 14215 110th Ave Jamaica NY 11435-5624 Ph: (917) 923-5341 | Legacy League Family Wellness Llc 14215 110th Ave Jamaica NY 11435-5624 Ph: (917) 923-5341 |
| NPI Number | 1487361234 |
|---|---|
| Provider Enumeration Date | 11/01/2022 |
| Last Update Date | 11/01/2022 |
| Certification Date | 11/01/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487361234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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