Provider Demographics
NPI:1477869758
Name:STOKES, JACQUELYN ANN (LADCA)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELYN
Middle Name:ANN
Last Name:STOKES
Suffix:
Gender:F
Credentials:LADCA
Other - Prefix:MISS
Other - First Name:JACQUELYN
Other - Middle Name:ANN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADCA
Mailing Address - Street 1:157 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2667
Mailing Address - Country:US
Mailing Address - Phone:617-983-5800
Mailing Address - Fax:617-983-5840
Practice Address - Street 1:157 GREEN ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2667
Practice Address - Country:US
Practice Address - Phone:617-983-5800
Practice Address - Fax:617-983-5840
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker