Doctor Name: | DR. JOANNE JACKAL |
NPI Number: | 1174702500 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D, LCSW CASAC |
License Number: | 2404 |
Business Practice Address: | 7 Undercliff Rd Millburn, NJ - 070411509 |
Business Phone Number: | 9735647651 |
Business Fax Number: | 9735647651 |
Mailing Address: | 7 Undercliff Rd, MILLBURN |
State: | NJ |
Postal Code: | 070411509 |
Phone Number: | 9735647651 |
Fax Number: | 9735647651 |
NPI Enumeration Date: | 11/01/2007 |
NPI Last Update Date: | 11/01/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 2404 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |