Provider Demographics
NPI:1679224281
Name:BSALES, JACLYN A (LCSW)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:A
Last Name:BSALES
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 1:116 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5630
Mailing Address - Country:US
Mailing Address - Phone:862-703-0893
Mailing Address - Fax:
Practice Address - Street 1:545 US HIGHWAY 46 STE 4
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1731
Practice Address - Country:US
Practice Address - Phone:862-703-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060596001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical