Provider Demographics
NPI:1710945803
Name:PASSERO, JACLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:PASSERO
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 1:2190 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-2746
Mailing Address - Country:US
Mailing Address - Phone:585-339-9150
Mailing Address - Fax:585-339-9150
Practice Address - Street 1:2190 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-2746
Practice Address - Country:US
Practice Address - Phone:585-339-9150
Practice Address - Fax:585-339-9150
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0232871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010023278OtherBLUE CROSS BLUE SHIELD
NY102044FKOtherPREFERRED CARE
TX7741364OtherAETNA
MN1095227OtherCIGNA BEHAVIORAL HEALTH
NYP010023278OtherMONROE PLAN
NYP010023278OtherBLUE CHOICE