Provider Demographics
NPI:1376208108
Name:PERRY, JACQUELINE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 SANDOWN CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-8091
Mailing Address - Country:US
Mailing Address - Phone:443-204-9734
Mailing Address - Fax:
Practice Address - Street 1:4010 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5502
Practice Address - Country:US
Practice Address - Phone:410-367-1089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2023-06-28
Deactivation Date:2022-09-30
Deactivation Code:
Reactivation Date:2023-06-28
Provider Licenses
StateLicense IDTaxonomies
MD267751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical