Individual
JACQUELINE M JAQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
770 E 176TH ST, BRONX, NY 10460-4617
(718) 583-5150
Mailing address
770 E 176TH ST, BRONX, NY 10460-4617
(718) 583-5150
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
36299
NY
Other
Enumeration date
07/08/2020
Last updated
07/08/2020
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