Provider Demographics
NPI:1851056956
Name:BARCO, JACQUELINE (PHD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BARCO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 LAKE AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1108
Mailing Address - Country:US
Mailing Address - Phone:412-212-8387
Mailing Address - Fax:
Practice Address - Street 1:13940 CEDAR RD STE 251
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3204
Practice Address - Country:US
Practice Address - Phone:412-212-8387
Practice Address - Fax:216-424-6760
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08705103TC1900X
OHE.2001950101YP2500X
PAPC014576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional