Healthcare Provider Details

I. General information

NPI: 1548908403
Provider Name (Legal Business Name): CHERYL JACKO LPC, ACS, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N UNION AVE STE 204
CRANFORD NJ
07016-2198
US

IV. Provider business mailing address

PO BOX 5
SPRINGFIELD NJ
07081-0005
US

V. Phone/Fax

Practice location:
  • Phone: 908-280-4149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00780800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: