Healthcare Provider Details

I. General information

NPI: 1811786031
Provider Name (Legal Business Name): JACLYN KOECK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RAY ST
PARSIPPANY NJ
07054-2335
US

IV. Provider business mailing address

10 RAY ST
PARSIPPANY NJ
07054-2335
US

V. Phone/Fax

Practice location:
  • Phone: 973-919-7439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01214300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: