| Jacqueline Durham, Llc. | |
|
214 Broad St Red Bank NJ 07701-2026 | |
| (732) 690-2611 | |
| Not Available |
| Full Name | Jacqueline Durham, Llc. |
|---|---|
| Speciality | Social Worker |
| Location | 214 Broad St, Red Bank, New Jersey |
| Authorized Official Name and Position | Kathleen M. Garcia (ACCOUNT MANAGER) |
| Authorized Official Contact | 8562423736 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacqueline Durham, Llc. 214 Broad St Red Bank NJ 07701-2026 Ph: (732) 690-2611 | Jacqueline Durham, Llc. 214 Broad St Red Bank NJ 07701-2026 Ph: (732) 690-2611 |
| NPI Number | 1295392850 |
|---|---|
| Provider Enumeration Date | 05/20/2019 |
| Last Update Date | 10/07/2019 |
| Medicare PECOS PAC ID | 1153650411 |
|---|---|
| Medicare Enrollment ID | O20190911002488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295392850 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jacqueline Durham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609235498 PECOS PAC ID: 0941599385 Enrollment ID: I20160525000967 |
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