Healthcare Provider Details

I. General information

NPI: 1043948045
Provider Name (Legal Business Name): JACQUELINE PLANTE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 TACOMA ST
WORCESTER MA
01605-3516
US

IV. Provider business mailing address

600 PENNSYLVANIA AVE APT 105
LEOMINSTER MA
01453-7401
US

V. Phone/Fax

Practice location:
  • Phone: 508-852-1805
  • Fax:
Mailing address:
  • Phone: 978-868-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1141740
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: