Provider Demographics
NPI:1609884485
Name:TAUSIG, JANE ELLEN (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:TAUSIG
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 FOX RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2808
Mailing Address - Country:US
Mailing Address - Phone:215-901-3185
Mailing Address - Fax:
Practice Address - Street 1:315 YORKTOWN PLZ
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1427
Practice Address - Country:US
Practice Address - Phone:215-901-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0149981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2233829000OtherPERSONAL CHOICE
027629OtherVALUE OPTIONS PIN
PA4271463OtherAETNA PROVIDER #
2233829000OtherPERSONAL CHOICE