Provider Demographics
NPI:1982473922
Name:BARON, JACQUELINE MONIQUE (LICSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MONIQUE
Last Name:BARON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 POAG ST APT 3132
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2472
Mailing Address - Country:US
Mailing Address - Phone:770-853-0881
Mailing Address - Fax:
Practice Address - Street 1:2803 POAG ST APT 3132
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-2472
Practice Address - Country:US
Practice Address - Phone:770-853-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000025871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical