Individual provider Active NPI

Jennifer Ann Hailey, PSY.D.

  • Clinical Psychologist
  • Lebanon, PA
National Provider Identifier
1861848012
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS018051 Issued in PA
Practice address
283 S Butler Rd
Lebanon, PA 17042-8939
Phone
(717) 273-8871
Fax
(717) 270-2452
NPI assigned
May 6, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS018051 PA
Clinical Psychologist 103TC0700X PS018051 PA Primary

Addresses

Primary practice location

283 S Butler Rd
Lebanon, PA 17042-8939

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other practice location 1

239 S Butler Rd
Lebanon, PA 17042-8939
Phone (717) 273-8871

Other identifiers 2

IdentifierTypeStateIssuer
PS018051OtherPASTATE LICENSE
103362605MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160805001534 PA Practitioner - Clinical Psychologist 7315231818 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Philhaven CurrentSince Jun 11, 2016 Accepting new patients
Philhaven Current Accepting new patients
Wellspan Medical Group Past Accepting new patients

Locations

785 5th Ave
Ste 3
Chambersburg, PA 17201

2501 Oregon Pike
Ste 113
Lancaster, PA 17601
Phone (717) 735-1954

283 S Butler Rd
Lebanon, PA 17042

204 Hathaway Park
Lebanon, PA 17042
Phone (717) 274-9777

283 Butler Rd
Mount Gretna, PA 17064
Phone (800) 932-0359

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1861848012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 S BUTLER RD",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170428939",
            "telephone_number": "717-273-8871",
            "fax_number": "717-270-2452"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "239 S Butler Rd",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170428939",
            "country_code": "US",
            "telephone_number": "717-273-8871",
            "fax_number": "717-270-2452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAILEY",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-06",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS018051",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS018051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PS018051",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103362605",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.