Provider Demographics
NPI:1801500632
Name:BABCOCK, JACLYN WEBER (PHD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:WEBER
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SUGARFIELD CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3353
Mailing Address - Country:US
Mailing Address - Phone:917-696-6301
Mailing Address - Fax:
Practice Address - Street 1:103D REGENCY COMMONS DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5210
Practice Address - Country:US
Practice Address - Phone:864-501-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1576103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist