MEDICARE: JACQUELINE CORPUZ LCSW-C

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	19867	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962888974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE CORPUZ LCSW-C

Provider Business Mailing Address
First Line	:	1220 E JOPPA RD STE 332
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-5811
Country	:	US
Telephone Number	:	667-600-3999
Fax Number	:	676-600-4102

Provider Business Practice Location Address
First Line	:	1220 E JOPPA RD STE 332
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-5811
Country	:	US
Telephone Number	:	667-600-3999
Fax Number	:	676-600-4102

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

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	12/06/2018

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