Provider Demographics
NPI:1962500744
Name:JAKSTIS, DAPHNE LYNN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:LYNN
Last Name:JAKSTIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-2006
Mailing Address - Country:US
Mailing Address - Phone:508-274-3831
Mailing Address - Fax:
Practice Address - Street 1:3088 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-4800
Practice Address - Country:US
Practice Address - Phone:508-295-7990
Practice Address - Fax:508-295-3781
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121601041C0700X
PACW0185831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical