Provider Demographics
NPI:1336923481
Name:DANTINNE, JACLYN ELIZABETH (MA, LAC)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:ELIZABETH
Last Name:DANTINNE
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 DESCHLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-2406
Mailing Address - Country:US
Mailing Address - Phone:856-889-0770
Mailing Address - Fax:
Practice Address - Street 1:18 GROVE ST
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1227
Practice Address - Country:US
Practice Address - Phone:856-499-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00737200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health