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NPI Code Detail

MEDICARE: MRS. JACQUELINE ANN PERTUSIELLO LCSW

MEDICARE: MRS. JACQUELINE ANN PERTUSIELLO LCSW
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
11041C0700XClinical Social WorkerSW4598FL

General Provider Information

NPI Number : 1750450904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELINE ANN PERTUSIELLO LCSW
Provider Business Mailing Address
First Line : 916 NW 126TH TER
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33071-4435
Country : US
Telephone Number : 954-341-9192
Fax Number :
Provider Business Practice Location Address
First Line : 19425 SW 58TH MNR
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33332-3338
Country : US
Telephone Number : 954-392-5689
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. JACQUELINE ANN PERTUSIELLO LCSW” Practice Location

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