Provider Demographics
NPI:1215174206
Name:MILLER, JACQUELINE CREQUE (MSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:CREQUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 EAST COMPTON BLVD.
Mailing Address - Street 2:DMH SPECIALIZED FOSTER CARE PROGRAM, 1ST FLOOR
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221
Mailing Address - Country:US
Mailing Address - Phone:310-668-6935
Mailing Address - Fax:310-898-1607
Practice Address - Street 1:921 E COMPTON BLVD
Practice Address - Street 2:DMH SPECIALIZED FOSTER CARE PROGRAM, 1ST FLOOR
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3303
Practice Address - Country:US
Practice Address - Phone:310-668-6935
Practice Address - Fax:310-898-1607
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS107011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical