Provider Demographics
NPI:1477382109
Name:JACQUELYN ZAGONE, APN, PMHNP-BC PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:JACQUELYN ZAGONE, APN, PMHNP-BC PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:ZAGONE
Authorized Official - Suffix:
Authorized Official - Credentials:APN, PMHNP-BC
Authorized Official - Phone:856-571-2139
Mailing Address - Street 1:12 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1850
Mailing Address - Country:US
Mailing Address - Phone:856-571-2139
Mailing Address - Fax:
Practice Address - Street 1:12 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1850
Practice Address - Country:US
Practice Address - Phone:856-571-2139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty