Provider Demographics
NPI:1871720896
Name:WASHINGTON, JACQUELINE ELIZABETH
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 BRINKLEY RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4962
Mailing Address - Country:US
Mailing Address - Phone:301-630-2955
Mailing Address - Fax:866-627-6394
Practice Address - Street 1:4008 BRINKLEY RD
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-4962
Practice Address - Country:US
Practice Address - Phone:301-630-2955
Practice Address - Fax:866-627-6394
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator