Provider Demographics
NPI:1184146474
Name:BARROSO, JACQUELINE M
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:BARROSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 JEFFERSON DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9475
Mailing Address - Country:US
Mailing Address - Phone:954-534-6525
Mailing Address - Fax:
Practice Address - Street 1:560 JEFFERSON DR UNIT 102
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9475
Practice Address - Country:US
Practice Address - Phone:954-534-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty