Provider Demographics
NPI:1790823714
Name:SINCLAIR, JENNIFER R (MED, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 W MAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-9051
Mailing Address - Country:US
Mailing Address - Phone:484-767-2728
Mailing Address - Fax:
Practice Address - Street 1:55 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2665
Practice Address - Country:US
Practice Address - Phone:610-588-0744
Practice Address - Fax:610-588-8944
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional