MEDICARE: JACQUELINE B KAPLAN LCSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW8902	FL
2	1041C0700X	Clinical Social Worker	LCSW13492	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW8902	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1063749786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE B KAPLAN LCSW LLC

Provider Business Mailing Address
First Line	:	1601 N TUCSON BLVD STE 38
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3410
Country	:	US
Telephone Number	:	520-901-0968
Fax Number	:	520-844-1033

Provider Business Practice Location Address
First Line	:	1601 N TUCSON BLVD STE 38
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3410
Country	:	US
Telephone Number	:	520-901-0968
Fax Number	:	520-844-1033

Authorized Official
Title or Position	:	CLINICAL PSYCHOTHERAPIST/OWNER
Name	:	JACQUELINE BARBARA KAPLAN
Credential	:	LCSW
Telephone Number	:	520-901-0968

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	01/04/2018

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