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General NPI Number Information
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NPI Number | 1497427470
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Entity Type | Individual
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Provider Name | JACQUELINE LUCIANA BOOKER MSW, CADC
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Gender | Female
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 2020 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3741
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Country | US
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Telephone | 312-572-4523
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Fax |
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Provider Business Mailing Address
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Address Line | 5325 S COTTAGE GROVE AVE APT 1005
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City | CHICAGO
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State | IL
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Zip | 60615-3640
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Country | US
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Telephone | 773-676-6713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-024490
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License Number State | IL
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