Provider Demographics
NPI:1972924728
Name:JACQUELINE DUKE, PSYD, LLC
Entity type:Organization
Organization Name:JACQUELINE DUKE, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANNALINA
Authorized Official - Last Name:CESARONI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-728-0705
Mailing Address - Street 1:3330 OLD GLENVIEW RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2963
Mailing Address - Country:US
Mailing Address - Phone:847-728-0705
Mailing Address - Fax:847-251-3685
Practice Address - Street 1:3330 OLD GLENVIEW RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:847-728-0705
Practice Address - Fax:847-251-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty