Provider Demographics
NPI:1932657509
Name:PRYOR, JACLYN A (LCSW)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:A
Last Name:PRYOR
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 1:343 E PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4241
Mailing Address - Country:US
Mailing Address - Phone:630-306-9955
Mailing Address - Fax:
Practice Address - Street 1:35 COURT ST STE 1C
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1709
Practice Address - Country:US
Practice Address - Phone:630-306-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060321001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical