MEDICARE: MRS. JACQUELINE AUGUSTA FERNANDES

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	106S00000X	Behavior Technician	S09966644	MA

General Provider Information

NPI Number	:	1558299354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE AUGUSTA FERNANDES

Provider Business Mailing Address
First Line	:	7 LAWRENCE ST STE 3
Second Line	:
City	:	TAUNTON
State	:	MA
Zip	:	02780-1700
Country	:	US
Telephone Number	:	508-951-3569
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 LAWRENCE ST STE 3
Second Line	:
City	:	TAUNTON
State	:	MA
Zip	:	02780-1700
Country	:	US
Telephone Number	:	508-951-3569
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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