Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS-006266-L | PA |
N | 103T00000X | Psychologist | PS-006266-L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103G00000X | Clinical Psychologist | PS-006266-L | PA |
N | 103TC0700X | Clinical Psychologist | PS-006266-L | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1639159866 |
---|---|
Provider Name | Ms. Lynn Calvin Jaeger |
First Address | Jenkintown, PA 19046-2232 |
Second Address | Jenkintown, PA 19046-2232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
JA763904 | BLUE SHIELD PROVIDER # (01) | PA |
PS-006266-L | LICENSE TO PRACTICE PSYCH (01) | PA |