Provider Demographics
NPI:1427328350
Name:FLETCHER, JACQUELINE (MSW, LISW-S)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23300 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5557
Mailing Address - Country:US
Mailing Address - Phone:440-429-3027
Mailing Address - Fax:216-291-0681
Practice Address - Street 1:23300 CHAGRIN BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5557
Practice Address - Country:US
Practice Address - Phone:440-429-3027
Practice Address - Fax:216-291-0681
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-1000037104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker