Provider Demographics
NPI:1780050021
Name:LAGUERRE, MARIE JACQUEDA (MASTER IN EDUCATION)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:JACQUEDA
Last Name:LAGUERRE
Suffix:
Gender:F
Credentials:MASTER IN EDUCATION
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:JACQUEDA
Other - Last Name:LAGUERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTER IN EDUCATION
Mailing Address - Street 1:4119 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4435
Mailing Address - Country:US
Mailing Address - Phone:347-702-7294
Mailing Address - Fax:718-676-6014
Practice Address - Street 1:5510 AVENUE I
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1706
Practice Address - Country:US
Practice Address - Phone:347-702-7294
Practice Address - Fax:718-676-6014
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator