Provider Demographics
NPI:1053025544
Name:JACQUES, GUESTHIA (LMSW)
Entity type:Individual
Prefix:
First Name:GUESTHIA
Middle Name:
Last Name:JACQUES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:GUESTHIA
Other - Middle Name:F
Other - Last Name:JACQUES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1407 E WASHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-1130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1407 E WASHINGTON LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1130
Practice Address - Country:US
Practice Address - Phone:917-386-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116170104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker