Provider Demographics
NPI:1932499837
Name:SMITH, JACQUELINE HARRIS (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HARRIS
Last Name:SMITH
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 1:1107 S PETERS ST
Mailing Address - Street 2:UNIT 211
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-1759
Mailing Address - Country:US
Mailing Address - Phone:504-919-7615
Mailing Address - Fax:
Practice Address - Street 1:1107 S PETERS ST
Practice Address - Street 2:UNIT 211
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-1759
Practice Address - Country:US
Practice Address - Phone:504-919-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical