Provider Demographics
NPI:1740952464
Name:MESECK, JACLYN
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:MESECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-9700
Mailing Address - Country:US
Mailing Address - Phone:973-222-2060
Mailing Address - Fax:
Practice Address - Street 1:71 SHADY LN
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-9700
Practice Address - Country:US
Practice Address - Phone:973-222-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst