Provider Demographics
NPI:1558810606
Name:CARNATION, JACLYN KATHLEEN (MS)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:KATHLEEN
Last Name:CARNATION
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2431
Mailing Address - Country:US
Mailing Address - Phone:215-760-7750
Mailing Address - Fax:
Practice Address - Street 1:2935 BYBERRY RD
Practice Address - Street 2:STE 108
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2815
Practice Address - Country:US
Practice Address - Phone:215-957-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor