Healthcare Provider Details

I. General information

NPI: 1164150652
Provider Name (Legal Business Name): SARAH JACQUES LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5026 DORSEY HALL DR STE 205
ELLICOTT CITY MD
21042-7854
US

IV. Provider business mailing address

2012 DRUID HILL AVE
BALTIMORE MD
21217-3518
US

V. Phone/Fax

Practice location:
  • Phone: 410-402-5615
  • Fax:
Mailing address:
  • Phone: 240-520-2913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number29018
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: