Provider Demographics
NPI:1538780010
Name:GERMANO, JACLYN ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:ELIZABETH
Last Name:GERMANO
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 1:131 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-5174
Mailing Address - Country:US
Mailing Address - Phone:617-733-6419
Mailing Address - Fax:
Practice Address - Street 1:44 EDGE HILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5309
Practice Address - Country:US
Practice Address - Phone:617-696-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221253101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool