1992837108 NPI number — MRS. JACQUELINE SIMONE MENARD LCSW

Table of content: MRS. JACQUELINE SIMONE MENARD LCSW (NPI 1992837108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992837108 NPI number — MRS. JACQUELINE SIMONE MENARD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENARD
Provider First Name:
JACQUELINE
Provider Middle Name:
SIMONE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992837108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 SNELL AVE APT 1606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95136-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-648-8661
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 SNELL AVE
Provider Second Line Business Practice Location Address:
APT 1606
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95136-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-648-8661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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