Provider Demographics
NPI:1073048229
Name:SINCLAIR, JACLYN (MT-BC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 WINDSOR AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2900
Mailing Address - Country:US
Mailing Address - Phone:860-518-5557
Mailing Address - Fax:
Practice Address - Street 1:122 WINDSOR AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2900
Practice Address - Country:US
Practice Address - Phone:860-518-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12213225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist