Provider Demographics
NPI:1780397679
Name:MOFFATT, JACQUELINE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FITCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1366
Mailing Address - Country:US
Mailing Address - Phone:857-930-6049
Mailing Address - Fax:203-601-9627
Practice Address - Street 1:50 FITCH ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1366
Practice Address - Country:US
Practice Address - Phone:857-930-6049
Practice Address - Fax:203-601-9627
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty