MEDICARE: TONI-LEE JACQUES LICSW

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	ISW02223	RI

General Provider Information

NPI Number	:	1376995464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI-LEE JACQUES LICSW

Provider Business Mailing Address
First Line	:	200 MAY ST
Second Line	:
City	:	S ATTLEBORO
State	:	MA
Zip	:	02703-5520
Country	:	US
Telephone Number	:	508-902-5919
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MAY ST
Second Line	:
City	:	S ATTLEBORO
State	:	MA
Zip	:	02703-5520
Country	:	US
Telephone Number	:	508-902-5919
Fax Number	:	508-902-5919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	11/09/2020

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