Provider Demographics
NPI:1407894017
Name:JACQUES, JUDITH (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:JACQUES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N COURT ST
Mailing Address - Street 2:#1131
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5110
Mailing Address - Country:US
Mailing Address - Phone:843-304-6400
Mailing Address - Fax:843-606-2500
Practice Address - Street 1:22904 LYDEN DR STE 104
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-7047
Practice Address - Country:US
Practice Address - Phone:239-494-3951
Practice Address - Fax:239-217-9561
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9952104100000X
MA1135701041C0700X
FLSW161121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker