Provider Demographics
NPI:1043025430
Name:KODOSKY, JACLYN (LMSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:KODOSKY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 FARRELL ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2620
Mailing Address - Country:US
Mailing Address - Phone:516-996-7040
Mailing Address - Fax:
Practice Address - Street 1:2545 HEMPSTEAD TPKE STE 105
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2147
Practice Address - Country:US
Practice Address - Phone:516-996-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079326104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker