Provider Demographics
NPI:1679875371
Name:JEWELL, DENISE MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7052 ROUTE 6N
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-9610
Mailing Address - Country:US
Mailing Address - Phone:814-734-3975
Mailing Address - Fax:814-734-1265
Practice Address - Street 1:7052 ROUTE 6N
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-9610
Practice Address - Country:US
Practice Address - Phone:814-734-3975
Practice Address - Fax:814-734-1265
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist