Provider Demographics
NPI:1275623605
Name:LARUE BARKER, JACQUELINE ANN (CSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANN
Last Name:LARUE BARKER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:LARUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 UPPER SAREPTA RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823
Mailing Address - Country:US
Mailing Address - Phone:908-475-4484
Mailing Address - Fax:
Practice Address - Street 1:492 RT 57 WEST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882
Practice Address - Country:US
Practice Address - Phone:908-689-6212
Practice Address - Fax:908-689-4529
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW01225800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker