Provider Demographics
NPI:1770991481
Name:PAISNER, JODI
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:PAISNER
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 1:5060 STATE ROAD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026
Mailing Address - Country:US
Mailing Address - Phone:610-626-8085
Mailing Address - Fax:610-626-8032
Practice Address - Street 1:5060 STATE ROAD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026
Practice Address - Country:US
Practice Address - Phone:610-626-8085
Practice Address - Fax:610-626-8032
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional