Healthcare Provider Details

I. General information

NPI: 1447397724
Provider Name (Legal Business Name): JACQUELINE MARIE GLORIOSO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JACKIE MARIE DUNCAN

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 PHILLIP ST
NEW ORLEANS LA
70113
US

IV. Provider business mailing address

1901 WESTBANK EXPY STE 200
HARVEY LA
70058-4362
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-3130
  • Fax:
Mailing address:
  • Phone: 318-221-1807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6744
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6744
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: