Jaclyn Mickiewicz, LICSW is a 
Social Worker - Clinical based in Shelburne Falls, Massachusetts. Jaclyn Mickiewicz is licensed to practice in Massachusetts (license number LICSW126010) and her current practice location is 
26 Severance St, Shelburne Falls, Massachusetts. She can be reached at her office (for appointments etc.) via phone at 
(413) 775-3432.
NPI number for Jaclyn Mickiewicz is 1295953461 and her current mailing address is 26 Severance St, Shelburne Falls, Massachusetts. She 
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1295953461.
			
			
			
		 
		
		 
Healthcare Provider's Profile
		
			
			
			| Full Name | Jaclyn Mickiewicz | 
|---|
| Gender | Female | 
|---|
| Speciality | Social Worker - Clinical | 
|---|
| Location | 26 Severance St, Shelburne Falls, Massachusetts | 
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. | 
|---|
			
			 
			
						  NPI Data:
			
			- NPI Number: 1295953461
- Provider Enumeration Date: 04/23/2007
- Last Update Date: 10/30/2024
 
		 
		 
Medical Identifiers
		Medical identifiers for Jaclyn Mickiewicz such as npi, medicare ID, medicare PIN, medicaid, etc.
		
		| Identifier | Type | State | Issuer | 
|---|
		| 1295953461 | NPI | - | NPPES | 
		
		 
Medical Taxonomies and Licenses
		
		| Taxonomy | Type | License (State) | Status | 
|---|
		| 101Y00000X | Counselor | (* (Not Available)) | Secondary | 
| 1041C0700X | Social Worker - Clinical | LICSW126010 (Massachusetts) | Primary | 
		
		
			
			
			
		
		
		 
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jaclyn Mickiewicz is 
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
		
		
 
Mailing Address and Practice Location
		
		| Mailing Address | Practice Location Address | 
|---|
		| Jaclyn Mickiewicz, LICSW 26 Severance St,
 Shelburne Falls, MA 01370-1217
 Ph: (413) 775-3432
 | Jaclyn Mickiewicz, LICSW 26 Severance St,
 Shelburne Falls, MA 01370-1217
 Ph: (413) 775-3432
 | 
		
		 
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