Provider Demographics
NPI:1073156659
Name:NOLAN, JACQUELINE YOLANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:YOLANDA
Last Name:NOLAN
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 1:16 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3849
Mailing Address - Country:US
Mailing Address - Phone:781-721-5814
Mailing Address - Fax:
Practice Address - Street 1:16 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-3849
Practice Address - Country:US
Practice Address - Phone:781-721-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219704104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker