Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OC010862 | PA |
NPI | 1053880559 |
---|---|
Provider Name | Mrs. Jaclyn Elizabeth Macchione |
First Address | Oreland, PA 19075-1114 |
Second Address | Philadelphia, PA 19128-3918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2018 |
Last Update Date | 14/11/2018 |