Provider Demographics
NPI:1639922396
Name:JACKIE THE SOCIAL WORKER
Entity Type:Organization
Organization Name:JACKIE THE SOCIAL WORKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKELINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-217-8662
Mailing Address - Street 1:4422 N RAVENSWOOD AVE # 1016
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5803
Mailing Address - Country:US
Mailing Address - Phone:773-217-8662
Mailing Address - Fax:888-690-5661
Practice Address - Street 1:4422 N RAVENSWOOD AVE # 1016
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5803
Practice Address - Country:US
Practice Address - Phone:773-217-8662
Practice Address - Fax:888-690-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health