Provider Demographics
NPI:1922606102
Name:PADGE, JAY (LPC)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:PADGE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1624 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3815
Mailing Address - Country:US
Mailing Address - Phone:148-955-4371
Mailing Address - Fax:
Practice Address - Street 1:1624 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3815
Practice Address - Country:US
Practice Address - Phone:814-244-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016818101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor