MEDICARE: JACLYN L. CROSSLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW98977	CA

General Provider Information

NPI Number	:	1477416378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN L. CROSSLEY LCSW

Provider Business Mailing Address
First Line	:	849 ALMAR AVE STE C
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5875
Country	:	US
Telephone Number	:	831-706-8532
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 SHERMAN ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-3434
Country	:	US
Telephone Number	:	831-706-8532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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