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General NPI Number Information
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NPI Number | 1740668219
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Entity Type | Individual
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Provider Name | JACQUELINE MCINTOSH
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Gender | Female
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1445 W BROWARD BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-1504
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Country | US
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Telephone | 954-712-2530
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Fax |
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Provider Business Mailing Address
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Address Line | 2833 NW 91ST AVE APT 104
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5066
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Country | US
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Telephone | 954-856-0054
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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 | MH24666
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License Number State | FL
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