Provider Demographics
NPI:1508961699
Name:EGAN, JEANETTE DONNA (MS,LPC, CAC-D,CCDP-D)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:DONNA
Last Name:EGAN
Suffix:
Gender:F
Credentials:MS,LPC, CAC-D,CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 BROAD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-3630
Mailing Address - Country:US
Mailing Address - Phone:610-965-3635
Mailing Address - Fax:610-965-3635
Practice Address - Street 1:860 BROAD ST STE 106
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-3630
Practice Address - Country:US
Practice Address - Phone:610-965-3635
Practice Address - Fax:610-965-3635
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000119101YP2500X, 101YM0800X
PACERTIFICATION#3933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health