Provider Demographics
NPI:1649039546
Name:HENEGHAN-GIANCHETTA, JACLYN (LAC)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:
Last Name:HENEGHAN-GIANCHETTA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2905
Mailing Address - Country:US
Mailing Address - Phone:203-962-4531
Mailing Address - Fax:
Practice Address - Street 1:43 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2905
Practice Address - Country:US
Practice Address - Phone:203-962-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist