Provider Demographics
NPI:1639527476
Name:MCINTOSH, JACQUELINE A (LCSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:A
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 BLACKROCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-6103
Mailing Address - Country:US
Mailing Address - Phone:914-562-2554
Mailing Address - Fax:
Practice Address - Street 1:159 20TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1253
Practice Address - Country:US
Practice Address - Phone:646-685-4499
Practice Address - Fax:516-218-7964
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32945101YA0400X
NY090562104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)