Provider Demographics
NPI:1255809802
Name:SEMMELES, JACLYN MARIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:SEMMELES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E HAYESTOWN RD UNIT 7
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2501
Mailing Address - Country:US
Mailing Address - Phone:203-723-3588
Mailing Address - Fax:
Practice Address - Street 1:24 STEVENS ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850
Practice Address - Country:US
Practice Address - Phone:203-852-2292
Practice Address - Fax:203-899-5206
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58.0097051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical