Healthcare Provider Details

I. General information

NPI: 1811502115
Provider Name (Legal Business Name): JACLYN MARIE TOMASETTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BECKS WOODS DR STE 100
BEAR DE
19701-3853
US

IV. Provider business mailing address

161 BECKS WOODS DR
BEAR DE
19701-3833
US

V. Phone/Fax

Practice location:
  • Phone: 302-797-1655
  • Fax:
Mailing address:
  • Phone: 302-797-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberQ1-0001719
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC05855500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: