Healthcare Provider Details

I. General information

NPI: 1154064913
Provider Name (Legal Business Name): MELINA JACKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 FEDERAL ST
CAMDEN NJ
08103-1539
US

IV. Provider business mailing address

1501 OLD BLACK HORSE PIKE APT L4
BLACKWOOD NJ
08012-4932
US

V. Phone/Fax

Practice location:
  • Phone: 856-583-2400
  • Fax:
Mailing address:
  • Phone: 856-534-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: