Provider Demographics
NPI:1487387510
Name:LABORDE-AGUIRRE, JENNIE GIZELLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:GIZELLE
Last Name:LABORDE-AGUIRRE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:AGUIRRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1713 SUMMERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-8130
Mailing Address - Country:US
Mailing Address - Phone:347-564-5640
Mailing Address - Fax:
Practice Address - Street 1:521 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3645
Practice Address - Country:US
Practice Address - Phone:718-869-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker