Provider Demographics
NPI:1760746721
Name:JOHN, JACQUELINE A (MSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:JOHN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 STEVENS RD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4701
Mailing Address - Country:US
Mailing Address - Phone:508-677-0304
Mailing Address - Fax:
Practice Address - Street 1:664 STEVENS RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4701
Practice Address - Country:US
Practice Address - Phone:508-677-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker