Provider Demographics
NPI:1811728884
Name:SARNECKY, JACQUELINE (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SARNECKY
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8373
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-8373
Mailing Address - Country:US
Mailing Address - Phone:213-293-5950
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 8373
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91327-8373
Practice Address - Country:US
Practice Address - Phone:213-293-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10696101YM0800X
CA17826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health