Basic Information
| Provider Information | |||||||||
| NPI: | 1366481152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HETSKO | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RIDILLA | ||||||||
| OtherFirstName: | JAIME | ||||||||
| OtherMiddleName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | MA, LPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1755 OREGON PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175815255 | ||||||||
| FaxNumber: | 7175815256 | ||||||||
| Practice Location | |||||||||
| Address1: | 3542 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174028626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516350 | ||||||||
| FaxNumber: | 7178513372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 09/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PC004047 | PA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | PC004047 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 649342-01 | 01 | PA | BC/BS OF MD CARE FIRST | OTHER | 832875000 | 01 | PA | MAGELLAN | OTHER | 2275891 | 01 | PA | CIGNA BEHAVIORAL HEALTH | OTHER | 50058267 | 01 | PA | CAPITAL BLUE CROSS | OTHER |