Provider Demographics
NPI:1790033520
Name:O'DUOR, JACQUELINE JAFFE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:JAFFE
Last Name:O'DUOR
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 1:5109 KINGSESSING AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-4327
Mailing Address - Country:US
Mailing Address - Phone:267-329-9393
Mailing Address - Fax:
Practice Address - Street 1:2305 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2515
Practice Address - Country:US
Practice Address - Phone:267-329-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0176761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical