Provider Demographics
NPI:1245716802
Name:MACHADO, JACQUELINE D (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:D
Last Name:MACHADO
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 1:14075 HESPERIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4500
Mailing Address - Country:US
Mailing Address - Phone:760-810-0000
Mailing Address - Fax:760-810-0178
Practice Address - Street 1:14075 HESPERIA RD STE 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4500
Practice Address - Country:US
Practice Address - Phone:760-810-0000
Practice Address - Fax:760-810-0178
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1005931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical