Provider Demographics
NPI:1003268913
Name:LAGUERRE, JACKELINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JACKELINE
Middle Name:
Last Name:LAGUERRE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JACKELINE
Other - Middle Name:
Other - Last Name:LAGUERRE-NUNEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:3018 KINGSBRIDGE AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5107
Mailing Address - Country:US
Mailing Address - Phone:646-271-0586
Mailing Address - Fax:
Practice Address - Street 1:3018 KINGSBRIDGE AVE APT 2N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5107
Practice Address - Country:US
Practice Address - Phone:646-271-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141397918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYYZ00043QMedicaid