Provider Demographics
NPI:1598805327
Name:JONES, JACLYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 21 160 STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1316
Mailing Address - Country:US
Mailing Address - Phone:718-321-8105
Mailing Address - Fax:516-719-9500
Practice Address - Street 1:29 21 160 STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1316
Practice Address - Country:US
Practice Address - Phone:718-321-8105
Practice Address - Fax:516-719-9500
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0703911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN32E11Medicare ID - Type UnspecifiedBCBS
NY07353Medicare ID - Type UnspecifiedGHI