Provider Demographics
NPI:1043630304
Name:MAYLE-TOWNE, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MAYLE-TOWNE
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 1:1125 OLD FORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2646
Mailing Address - Country:US
Mailing Address - Phone:845-419-2070
Mailing Address - Fax:
Practice Address - Street 1:4184 RT 9W
Practice Address - Street 2:
Practice Address - City:WEST CAMP
Practice Address - State:NY
Practice Address - Zip Code:12490
Practice Address - Country:US
Practice Address - Phone:845-247-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator