Healthcare Provider Details

I. General information

NPI: 1154885127
Provider Name (Legal Business Name): JACLYN PAIGE CHIARELLI MOODY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E LEXINGTON AVE
OCEANSIDE NY
11572-5421
US

IV. Provider business mailing address

106 E LEXINGTON AVE
OCEANSIDE NY
11572-5421
US

V. Phone/Fax

Practice location:
  • Phone: 516-850-0263
  • Fax:
Mailing address:
  • Phone: 516-850-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: