Provider Demographics
NPI:1568000537
Name:MASELLA, JACQUELYN ANN
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ANN
Last Name:MASELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:ANN
Other - Last Name:MASELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 WHIPPORWILL RD
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-7913
Mailing Address - Country:US
Mailing Address - Phone:540-692-2802
Mailing Address - Fax:
Practice Address - Street 1:316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1254
Practice Address - Country:US
Practice Address - Phone:540-908-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker