Provider Demographics
NPI:1992837108
Name:MENARD, JACQUELINE SIMONE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:SIMONE
Last Name:MENARD
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 1:4501 SNELL AVE APT 1606
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2358
Mailing Address - Country:US
Mailing Address - Phone:408-648-8661
Mailing Address - Fax:
Practice Address - Street 1:4501 SNELL AVE
Practice Address - Street 2:APT 1606
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-2346
Practice Address - Country:US
Practice Address - Phone:408-648-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker