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NPI Code Detail

MEDICARE: MS. JACQUELINE A MCINTOSH LCSW, CASAC

MEDICARE: MS. JACQUELINE A MCINTOSH LCSW, CASAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor32945NY
2104100000XSocial Worker090562NY

General Provider Information

NPI Number : 1639527476
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE A MCINTOSH LCSW, CASAC
Provider Business Mailing Address
First Line : 2015 BLACKROCK AVE
Second Line :
City : BRONX
State : NY
Zip : 10472-6103
Country : US
Telephone Number : 914-562-2554
Fax Number :
Provider Business Practice Location Address
First Line : 159 20TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-1253
Country : US
Telephone Number : 646-685-4499
Fax Number : 516-218-7964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2016
Last Update Date : 11/03/2020

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