Provider Demographics
NPI:1689187551
Name:ROUSSEAUX-PERSHING, JACQUELINE MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MICHELE
Last Name:ROUSSEAUX-PERSHING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2406
Mailing Address - Country:US
Mailing Address - Phone:831-392-5757
Mailing Address - Fax:
Practice Address - Street 1:16 S RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2406
Practice Address - Country:US
Practice Address - Phone:831-392-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1196011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical