Provider Demographics
NPI:1922273093
Name:KAPLAN, JACQUELINE BARBARA (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BARBARA
Last Name:KAPLAN
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 1:1601 N TUCSON BLVD STE 38
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3410
Mailing Address - Country:US
Mailing Address - Phone:520-901-0968
Mailing Address - Fax:520-844-1033
Practice Address - Street 1:1601 N TUCSON BLVD STE 38
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3410
Practice Address - Country:US
Practice Address - Phone:520-901-0968
Practice Address - Fax:520-844-1033
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-134921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-13492OtherLCSW-13492