Provider Demographics
NPI:1083035794
Name:DEMONTREUX, JACLYN ANNA MARIE (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:ANNA MARIE
Last Name:DEMONTREUX
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W BROAD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5778
Mailing Address - Country:US
Mailing Address - Phone:484-714-6373
Mailing Address - Fax:
Practice Address - Street 1:308 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6311
Practice Address - Country:US
Practice Address - Phone:610-861-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional