Provider Demographics
NPI:1881186591
Name:BURWELL, JACLYN H (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:H
Last Name:BURWELL
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 1:192 JOAN DR
Mailing Address - Street 2:
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1957
Mailing Address - Country:US
Mailing Address - Phone:610-403-9135
Mailing Address - Fax:
Practice Address - Street 1:192 JOAN DR
Practice Address - Street 2:
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-1957
Practice Address - Country:US
Practice Address - Phone:610-403-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0110531041C0700X
NCC0121561041C0700X
PACW0232841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty