Individual
JACALYN D SPACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5 TRIANGLE RD, LIBERTY, NY 12754-3368
(845) 747-2580
(845) 292-0121
Mailing address
PO BOX 390, WESTBROOKVILLE, NY 12785-0390
(845) 224-7684
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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