Provider Demographics
NPI:1164150652
Name:JACQUES, SARAH (LMSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JACQUES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 CHEVY CHASE DR APT 105
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6438
Mailing Address - Country:US
Mailing Address - Phone:240-520-2913
Mailing Address - Fax:
Practice Address - Street 1:18213 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1422
Practice Address - Country:US
Practice Address - Phone:301-417-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29018104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD29018OtherMARYLAND DEPARTMENT OF HEALTH