Provider Demographics
NPI:1487986154
Name:JEANETTE EGAN
Entity type:Organization
Organization Name:JEANETTE EGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:DONNA
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CAC-D
Authorized Official - Phone:610-965-3635
Mailing Address - Street 1:860 BROAD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-3630
Mailing Address - Country:US
Mailing Address - Phone:610-965-5790
Mailing Address - Fax:610-965-5790
Practice Address - Street 1:860 BROAD ST STE 106
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-3630
Practice Address - Country:US
Practice Address - Phone:610-965-5790
Practice Address - Fax:610-965-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000119101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty