Provider Demographics
NPI:1386293496
Name:JACLYN B. DEVINE PSYD PLLC
Entity type:Organization
Organization Name:JACLYN B. DEVINE PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:718-607-9081
Mailing Address - Street 1:51 WINDING POND RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3371
Mailing Address - Country:US
Mailing Address - Phone:718-607-9081
Mailing Address - Fax:
Practice Address - Street 1:204 ANDOVER ST STE 403
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5702
Practice Address - Country:US
Practice Address - Phone:718-607-9081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty