Provider Demographics
NPI:1548411614
Name:PLACIDI, JACKIE (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:PLACIDI
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21610 E 11 MILE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1671
Mailing Address - Country:US
Mailing Address - Phone:586-778-7800
Mailing Address - Fax:
Practice Address - Street 1:21610 E 11 MILE RD STE 5
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1671
Practice Address - Country:US
Practice Address - Phone:586-778-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090134104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker