Healthcare Provider Details

I. General information

NPI: 1457266827
Provider Name (Legal Business Name): MADELYN LEIGH SACCO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 12TH ST
HAMMONTON NJ
08037-9153
US

IV. Provider business mailing address

331 TILTON RD STE 29
NORTHFIELD NJ
08225-1201
US

V. Phone/Fax

Practice location:
  • Phone: 609-833-7613
  • Fax:
Mailing address:
  • Phone: 609-833-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00982800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: