Provider Demographics
NPI:1215418009
Name:DUCHIN, JACQUELINE NANCY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:NANCY
Last Name:DUCHIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 HAMMOND ST UNIT EPH15
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2167
Mailing Address - Country:US
Mailing Address - Phone:617-462-4602
Mailing Address - Fax:
Practice Address - Street 1:629 HAMMOND ST UNIT EPH15
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2167
Practice Address - Country:US
Practice Address - Phone:617-462-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1064081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical