Provider Demographics
NPI:1366481152
Name:HETSKO, JAIME (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:HETSKO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:RIDILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1755 OREGON PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4272
Mailing Address - Country:US
Mailing Address - Phone:717-581-5255
Mailing Address - Fax:717-581-5256
Practice Address - Street 1:3542 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6350
Practice Address - Fax:717-851-3372
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004047101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA649342-01OtherBC/BS OF MD CARE FIRST
PA832875000OtherMAGELLAN
PA2275891OtherCIGNA BEHAVIORAL HEALTH
PA50058267OtherCAPITAL BLUE CROSS