Healthcare Provider Details

I. General information

NPI: 1346027000
Provider Name (Legal Business Name): ACKEEM CARTO LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 PASSAIC AVE STE 200
FAIRFIELD NJ
07004-3526
US

IV. Provider business mailing address

PO BOX 49
ENGLEWOOD NJ
07631-0049
US

V. Phone/Fax

Practice location:
  • Phone: 800-413-8020
  • Fax: 732-479-6751
Mailing address:
  • Phone: 800-413-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01252100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018627
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: