Provider Demographics
NPI:1194151795
Name:SANFLIPPO, JACQUELINE (LAC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:SANFLIPPO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1814
Mailing Address - Country:US
Mailing Address - Phone:856-547-1107
Mailing Address - Fax:
Practice Address - Street 1:535 BRIDGEBORO ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08075-3328
Practice Address - Country:US
Practice Address - Phone:609-254-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00130900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor