Provider Demographics
NPI:1902514656
Name:MEINDL, JACLYNN MARRIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JACLYNN
Middle Name:MARRIE
Last Name:MEINDL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 ST BASILS RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-4127
Mailing Address - Country:US
Mailing Address - Phone:845-554-3343
Mailing Address - Fax:914-221-7750
Practice Address - Street 1:79 ST BASILS RD
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-4127
Practice Address - Country:US
Practice Address - Phone:845-554-3343
Practice Address - Fax:914-221-7750
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093817-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical