Provider Demographics
NPI:1255688511
Name:ECONOMOPOULOS, JACQUELYN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:ECONOMOPOULOS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:GLESSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:144 LINDEN CT S
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-2925
Mailing Address - Country:US
Mailing Address - Phone:484-274-0659
Mailing Address - Fax:
Practice Address - Street 1:2200 HAMILTON ST STE 200
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6329
Practice Address - Country:US
Practice Address - Phone:610-821-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007794101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional