Spiegel, Jaclyn

Spiegel, Jaclyn is an individual health care provider with primary practice located at 1428 5Th Ave , Bay Shore NY 11706-4147. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / School, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Clinical Child & Adolescent is her primary health care specialty. Spiegel, Jaclyn can be contacted via phone (631) 665-1900.

Contact Information

Primary practice address
1428 5Th Ave Bay Shore NY 11706-4147
Phone: (631) 665-1900
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 103TS0200X 1875262 New York
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 019721 New York

Profile Details

NPI number 1154618635
LBN Legal business name Spiegel, Jaclyn
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2011
Last updated Sep 18th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154618635 NPPES
New York MEDICAID 03926969

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