Provider Demographics
NPI:1114344645
Name:RIORDAN JAQUITH, JENNIFER R (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:RIORDAN JAQUITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:JAQUITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2124 NW 159TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2441
Mailing Address - Country:US
Mailing Address - Phone:954-401-2453
Mailing Address - Fax:
Practice Address - Street 1:18503 PINES BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1404
Practice Address - Country:US
Practice Address - Phone:954-392-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW65391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical