Provider Demographics
NPI:1760163737
Name:SPIEGEL, JACLYN (LSW)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S 19TH ST APT 1004
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4667
Mailing Address - Country:US
Mailing Address - Phone:631-375-4673
Mailing Address - Fax:
Practice Address - Street 1:2005 MARKET ST STE 3140
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7001
Practice Address - Country:US
Practice Address - Phone:631-375-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1403821041C0700X
NJ44SL069537001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical