Provider Demographics
NPI:1114598398
Name:WERTEL, JACQUELYN KARAH (MA, CAS)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:KARAH
Last Name:WERTEL
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 ELLSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3302
Mailing Address - Country:US
Mailing Address - Phone:518-222-2684
Mailing Address - Fax:
Practice Address - Street 1:1224 ELLSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3302
Practice Address - Country:US
Practice Address - Phone:518-222-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool