Provider Demographics
NPI:1073309670
Name:MACIEJEWSKI, JARED ANTHONY (LSW)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:ANTHONY
Last Name:MACIEJEWSKI
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ROOP ST
Mailing Address - Street 2:
Mailing Address - City:HIGHSPIRE
Mailing Address - State:PA
Mailing Address - Zip Code:17034-1244
Mailing Address - Country:US
Mailing Address - Phone:570-490-8964
Mailing Address - Fax:
Practice Address - Street 1:114 ROOP ST
Practice Address - Street 2:
Practice Address - City:HIGHSPIRE
Practice Address - State:PA
Practice Address - Zip Code:17034-1244
Practice Address - Country:US
Practice Address - Phone:570-490-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136776104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker