Provider Demographics
NPI:1447734199
Name:JACQUES, CHERYL (LICSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:JACQUES
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 1:5 CAPTAINS WAY
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1084
Mailing Address - Country:US
Mailing Address - Phone:508-378-9273
Mailing Address - Fax:
Practice Address - Street 1:5 CAPTAINS WAY
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1084
Practice Address - Country:US
Practice Address - Phone:508-378-9273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021497-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical