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General NPI Number Information
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NPI Number | 1639532237
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Entity Type | Organization
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Legal Business Name | JACQUELINE JAFFE O'DUOR, LLC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 2305 FAIRMOUNT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2515
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Country | US
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Telephone | 267-329-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 5109 KINGSESSING AVE SUITE 2
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City | PHILADELPHIA
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State | PA
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Zip | 19143-4327
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Country | US
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Telephone | 267-329-9393
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKR
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Name | MRS. JACQUELINE JAFFE O'DUOR
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Credential | LCSW
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Telephone | 267-329-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 017676
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License Number State | PA
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