Provider Demographics
NPI:1548494776
Name:LINDSAY, JACQUELYN A (LCSW-R)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:A
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-0043
Mailing Address - Country:US
Mailing Address - Phone:845-849-1958
Mailing Address - Fax:888-972-5017
Practice Address - Street 1:1 FOREST VIEW DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6440
Practice Address - Country:US
Practice Address - Phone:845-430-0414
Practice Address - Fax:888-972-5017
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047330-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300041522Medicare PIN