Provider Demographics
NPI:1255742193
Name:MARKWARD, JACQUELINE (MS, LPC, BSL)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MARKWARD
Suffix:
Gender:F
Credentials:MS, LPC, BSL
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:CAPOZZOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, BSL
Mailing Address - Street 1:410 N. PRINCE STREET
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 N. PRINCE STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603
Practice Address - Country:US
Practice Address - Phone:484-809-1738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001875103K00000X
PAPC008893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst