Provider Demographics
NPI:1285937706
Name:CHERRY, JACQUELINE CHRISTINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NICOLE WAY
Mailing Address - Street 2:CITY
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6810
Mailing Address - Country:US
Mailing Address - Phone:877-398-8269
Mailing Address - Fax:
Practice Address - Street 1:1171 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-4346
Practice Address - Country:US
Practice Address - Phone:347-271-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0731541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical