Provider Demographics
NPI:1154885127
Name:CHIARELLI, JACLYN PAIGE (LMSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:PAIGE
Last Name:CHIARELLI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TERRELL AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1124
Mailing Address - Country:US
Mailing Address - Phone:516-850-0263
Mailing Address - Fax:
Practice Address - Street 1:99 TULIP AVE STE 305
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1974
Practice Address - Country:US
Practice Address - Phone:516-850-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100252104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker