Provider Demographics
NPI:1811502115
Name:TOMASETTI, JACLYN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:TOMASETTI
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 1:161 BECKS WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3833
Mailing Address - Country:US
Mailing Address - Phone:302-797-1655
Mailing Address - Fax:
Practice Address - Street 1:121 BECKS WOODS DR STE 100
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3853
Practice Address - Country:US
Practice Address - Phone:302-797-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05855500101YM0800X
DEQ1-0001719101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health