Provider Demographics
NPI:1558024752
Name:ALTEBRANDO, JACLYN M (LGPC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:ALTEBRANDO
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2705
Mailing Address - Country:US
Mailing Address - Phone:908-347-8427
Mailing Address - Fax:
Practice Address - Street 1:1206 YORK RD STE 202
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6217
Practice Address - Country:US
Practice Address - Phone:443-718-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health