MEDICARE: MRS. JACQUELINE SIMONE MENARD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1992837108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE SIMONE MENARD LCSW

Provider Business Mailing Address
First Line	:	4501 SNELL AVE APT 1606
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95136-2358
Country	:	US
Telephone Number	:	408-648-8661
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 SNELL AVE
Second Line	:	APT 1606
City	:	SAN JOSE
State	:	CA
Zip	:	95136-2346
Country	:	US
Telephone Number	:	408-648-8661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	02/14/2013

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