Provider Demographics
NPI:1104881846
Name:FAFFER, JACLYNN I (DSW; LCSW)
Entity type:Individual
Prefix:DR
First Name:JACLYNN
Middle Name:I
Last Name:FAFFER
Suffix:
Gender:F
Credentials:DSW; LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 KITTIWAKE CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8864
Mailing Address - Country:US
Mailing Address - Phone:239-431-7709
Mailing Address - Fax:239-431-7713
Practice Address - Street 1:4719 KITTIWAKE CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8864
Practice Address - Country:US
Practice Address - Phone:239-431-7709
Practice Address - Fax:239-431-7713
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW55161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98800OtherBCBS GROUP NUMBER