MEDICARE: DR JACKIE PLLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1639715287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JACKIE PLLC

Provider Business Mailing Address
First Line	:	8208 VENOSA HAVEN TER
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-5029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8208 VENOSA HAVEN TER
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-5029
Country	:	US
Telephone Number	:	561-423-1811
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. JACQUELINE SABARESE
Credential	:	PHD
Telephone Number	:	631-872-1198

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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Directions to “DR JACKIE PLLC ” Practice Location

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