Provider Demographics
NPI:1740694652
Name:MACNEILL, JANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:MACNEILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTOM
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-354-0777
Mailing Address - Fax:215-354-0772
Practice Address - Street 1:504 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTOM
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-354-0777
Practice Address - Fax:215-354-0772
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0140431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical