Individual
JACQUELINE M SHOCK-STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12311 PERRY HWY, WEXFORD, PA 15090-8344
(878) 332-4240
(878) 332-4481
Mailing address
12311 PERRY HWY, WEXFORD, PA 15090-8344
(878) 332-4240
(878) 332-4481
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW017735
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103077862
—
PA
Enumeration date
06/13/2013
Last updated
10/12/2020
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