Provider Demographics
NPI:1740176593
Name:HAVERFORD PSYCHOLOGICAL AND CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:HAVERFORD PSYCHOLOGICAL AND CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELLYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENGST
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-331-6493
Mailing Address - Street 1:539 OLD LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1415
Mailing Address - Country:US
Mailing Address - Phone:610-331-6493
Mailing Address - Fax:
Practice Address - Street 1:30 S VALLEY RD STE 307
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1476
Practice Address - Country:US
Practice Address - Phone:610-331-6493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty