Provider Demographics
NPI:1134480916
Name:FUSCO, JACQUELINE A (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:A
Last Name:FUSCO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 NESHAMINY BLVD
Mailing Address - Street 2:APT 539
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1755
Mailing Address - Country:US
Mailing Address - Phone:215-932-9873
Mailing Address - Fax:
Practice Address - Street 1:1609 WOODBOURNE RD
Practice Address - Street 2:SUITE 401 B
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1500
Practice Address - Country:US
Practice Address - Phone:215-932-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist