Provider Demographics
NPI:1023174653
Name:SCHWARTZ, JACQUELINE (LMHC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:FLEISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRC
Mailing Address - Street 1:6 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617
Mailing Address - Country:US
Mailing Address - Phone:315-386-5205
Mailing Address - Fax:
Practice Address - Street 1:5862 SH 11
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-379-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health