Provider Demographics
NPI:1417357179
Name:DUKART, JACQUELINE (BCBA, BSL)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DUKART
Suffix:
Gender:F
Credentials:BCBA, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2946
Mailing Address - Country:US
Mailing Address - Phone:215-971-4654
Mailing Address - Fax:
Practice Address - Street 1:2616 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2946
Practice Address - Country:US
Practice Address - Phone:215-971-4654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001339103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst