Provider Demographics
NPI:1962215988
Name:JAQUEZ DE LA CRUZ, PATRICIA S (LSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:JAQUEZ DE LA CRUZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2344
Mailing Address - Country:US
Mailing Address - Phone:484-809-5201
Mailing Address - Fax:
Practice Address - Street 1:218 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3508
Practice Address - Country:US
Practice Address - Phone:484-640-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker