Provider Demographics
NPI:1629387410
Name:ESQUEF-NEDERLK, JACQUELINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:ESQUEF-NEDERLK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 QUARTZ AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1446
Mailing Address - Country:US
Mailing Address - Phone:818-269-9582
Mailing Address - Fax:818-886-8597
Practice Address - Street 1:8342 QUARTZ AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-1446
Practice Address - Country:US
Practice Address - Phone:818-269-9582
Practice Address - Fax:818-886-8597
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical