Provider Demographics
NPI:1932454915
Name:BARNES, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BARNES
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 1:3135 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2531
Mailing Address - Country:US
Mailing Address - Phone:216-391-2030
Mailing Address - Fax:216-391-8946
Practice Address - Street 1:3135 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2531
Practice Address - Country:US
Practice Address - Phone:216-391-2030
Practice Address - Fax:216-391-8946
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2015-07-24
Deactivation Date:2012-09-11
Deactivation Code:
Reactivation Date:2015-07-24
Provider Licenses
StateLicense IDTaxonomies
OH965617101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)