Healthcare Provider Details

I. General information

NPI: 1477382109
Provider Name (Legal Business Name): JACQUELYN ZAGONE, APN, PMHNP-BC PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 EGG HARBOR RD STE 800
SEWELL NJ
08080-9409
US

IV. Provider business mailing address

12 W WILLOW ST
WENONAH NJ
08090-1850
US

V. Phone/Fax

Practice location:
  • Phone: 856-689-7616
  • Fax: 866-521-4015
Mailing address:
  • Phone: 856-571-2139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELYN REGINA ZAGONE
Title or Position: OWNER
Credential: APN, PMHNP-BC
Phone: 856-571-2139