Provider Demographics
NPI:1154773786
Name:FOURNIER, JACQUELINE (LCSW-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 ALMANAC DR
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1950
Mailing Address - Country:US
Mailing Address - Phone:301-704-0973
Mailing Address - Fax:
Practice Address - Street 1:14605 ALMANAC DR
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1950
Practice Address - Country:US
Practice Address - Phone:301-704-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical