Provider Demographics
NPI:1215344346
Name:VALENCIA-CLARKE, JACQUELINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:VALENCIA-CLARKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4 WALSH WAY
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3026
Mailing Address - Country:US
Mailing Address - Phone:917-806-9573
Mailing Address - Fax:
Practice Address - Street 1:4 WALSH WAY
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3026
Practice Address - Country:US
Practice Address - Phone:917-806-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054307001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical