Provider Demographics
NPI:1194547182
Name:DUJARRIC, JACLYN T (PSYD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:T
Last Name:DUJARRIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12115 NATALIES COVE RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-5448
Mailing Address - Country:US
Mailing Address - Phone:954-376-0441
Mailing Address - Fax:
Practice Address - Street 1:12115 NATALIES COVE RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-5448
Practice Address - Country:US
Practice Address - Phone:954-376-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12445103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical