Provider Demographics
NPI:1942849427
Name:MACCHIAVERNA, JENNIFER MARIE (LCSW, LCDC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:MACCHIAVERNA
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:512-759-6575
Mailing Address - Fax:512-703-1394
Practice Address - Street 1:5015 S IH 35 STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-2714
Practice Address - Country:US
Practice Address - Phone:512-804-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2023-02-28
Deactivation Date:2019-12-31
Deactivation Code:
Reactivation Date:2020-01-07
Provider Licenses
StateLicense IDTaxonomies
TX14828101YA0400X
TX688371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)