Provider Demographics
NPI:1588996227
Name:LEIT, JACLYN PAIGE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:PAIGE
Last Name:LEIT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:JACLYN
Other - Middle Name:PAIGE
Other - Last Name:LEIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:204 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1723
Mailing Address - Country:US
Mailing Address - Phone:201-207-0376
Mailing Address - Fax:973-226-1506
Practice Address - Street 1:204 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1723
Practice Address - Country:US
Practice Address - Phone:201-207-0376
Practice Address - Fax:973-226-1506
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051409001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical