Provider Demographics
NPI:1124829494
Name:SMITH, JACQUELINE SUZANNE (MA LAPC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:SUZANNE
Last Name:SMITH
Suffix:
Gender:
Credentials:MA LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 SANTA BARBARA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4106
Mailing Address - Country:US
Mailing Address - Phone:717-936-9758
Mailing Address - Fax:
Practice Address - Street 1:1891 SANTA BARBARA DR STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4106
Practice Address - Country:US
Practice Address - Phone:717-936-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC001070101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health