Provider Information for 1295953461
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JACLYN MICKIEWICZ LICSW
Sex: Female
NPI: 1295953461
Last Updated: 2024-10-30
Certification Date: 2024-10-01
Certification Date: 2024-10-01
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1295953461 | ||||||||||||
| Enumeration Date | 2007-04-23 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 26 SEVERANCE ST SHELBURNE FALLS, MA 01370-1217 United States Phone: 413-775-3432 | Fax: | ||||||||||||
| Primary Practice Address | 26 SEVERANCE ST SHELBURNE FALLS, MA 01370-1217 United States Phone: 413-775-3432 | Fax: | ||||||||||||
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