Individual
JACQUELINE CORPUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
1220 E JOPPA RD STE 332, TOWSON, MD 21286-5811
(667) 600-3999
(676) 600-4102
Mailing address
1220 E JOPPA RD STE 332, TOWSON, MD 21286-5811
(667) 600-3999
(676) 600-4102
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
19867
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
608401000
—
MD
Enumeration date
08/03/2015
Last updated
12/06/2018
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