Provider Demographics
NPI:1093318537
Name:JAEGLY, JASON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:JAEGLY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 AUTEN RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-5057
Mailing Address - Country:US
Mailing Address - Phone:908-295-9582
Mailing Address - Fax:
Practice Address - Street 1:1 BALA AVE STE 110
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3207
Practice Address - Country:US
Practice Address - Phone:267-202-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical