Healthcare Provider Details

I. General information

NPI: 1255742193
Provider Name (Legal Business Name): JACQUELINE MARKWARD M.S., L.P.C., B.S.L.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE CAPOZZOLI M.S., L.P.C., B.S.L.

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N. PRINCE STREET
LANCASTER PA
17603
US

IV. Provider business mailing address

410 N. PRINCE STREET
LANCASTER PA
17603
US

V. Phone/Fax

Practice location:
  • Phone: 484-809-1738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008893
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH001875
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: