Provider Demographics
NPI:1013002617
Name:MULLER, JACQUELINE B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:B
Last Name:MULLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-2301
Mailing Address - Country:US
Mailing Address - Phone:845-702-1042
Mailing Address - Fax:845-709-8434
Practice Address - Street 1:3 MARKET ST
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-2301
Practice Address - Country:US
Practice Address - Phone:845-702-1042
Practice Address - Fax:845-709-8434
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0564891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02869556Medicaid
NY20-8949528OtherTAX ID