Provider Demographics
NPI:1487719936
Name:HERRING, JACLYN (PHD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:HERRING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 CROWE AVE
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-3303
Mailing Address - Country:US
Mailing Address - Phone:724-772-4949
Mailing Address - Fax:724-625-4949
Practice Address - Street 1:195 CROWE AVE
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-3303
Practice Address - Country:US
Practice Address - Phone:724-772-4949
Practice Address - Fax:724-625-4949
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007806L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHE821221Medicare ID - Type Unspecified