Provider Demographics
NPI:1336356070
Name:DREYFUS, JACQUELINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:DREYFUS
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 1:488 NORTON PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1638
Mailing Address - Country:US
Mailing Address - Phone:203-435-8174
Mailing Address - Fax:203-547-7900
Practice Address - Street 1:488 NORTON PKWY
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1638
Practice Address - Country:US
Practice Address - Phone:203-435-8174
Practice Address - Fax:203-547-7900
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089108-011041C0700X
CT0046191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY089108-01OtherLCSW LICENSE
CT008046036Medicaid
CT004619OtherLCSW LICENSE