Provider Demographics
NPI:1659400067
Name:DAGIA, JENNIFER S (PSYD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:DAGIA
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 HILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-2303
Mailing Address - Country:US
Mailing Address - Phone:609-254-6477
Mailing Address - Fax:
Practice Address - Street 1:928 JAYMOR RD STE B-150
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3853
Practice Address - Country:US
Practice Address - Phone:215-947-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171181041C0700X
PAPS019361103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ492916000Medicare UPIN