Provider Demographics
NPI:1710283148
Name:SOCASTRO, JACQUELINE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:SOCASTRO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAMARONECK AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1613
Mailing Address - Country:US
Mailing Address - Phone:917-355-4260
Mailing Address - Fax:
Practice Address - Street 1:600 MAMARONECK AVE STE 400
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1613
Practice Address - Country:US
Practice Address - Phone:917-355-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060860001041C0700X
NY0769541041C0700X
NY076954-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical