Provider Demographics
NPI:1598103053
Name:SEBASTIANELLI, JEANNA (MA, LBS, LPC)
Entity Type:Individual
Prefix:MS
First Name:JEANNA
Middle Name:
Last Name:SEBASTIANELLI
Suffix:
Gender:F
Credentials:MA, LBS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E SHORE DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-3909
Mailing Address - Country:US
Mailing Address - Phone:570-241-8453
Mailing Address - Fax:
Practice Address - Street 1:17 E SHORE DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18436-3909
Practice Address - Country:US
Practice Address - Phone:570-241-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008707101YP2500X, 101YP2500X
PABH001904101YP2500X
101YP2500X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional