Provider Demographics
NPI:1962999375
Name:FRANCISCUS, JACQUELINE LEIGH (LAC, NCC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LEIGH
Last Name:FRANCISCUS
Suffix:
Gender:F
Credentials:LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-1319
Mailing Address - Country:US
Mailing Address - Phone:908-500-0216
Mailing Address - Fax:
Practice Address - Street 1:270 DAVIDSON AVE STE 105
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4141
Practice Address - Country:US
Practice Address - Phone:732-328-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00254600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor