Healthcare Provider Details

I. General information

NPI: 1932987617
Provider Name (Legal Business Name): JACLYN MARIE PARADISE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CLARKSVILLE RD STE 1
WEST WINDSOR NJ
08550-5300
US

IV. Provider business mailing address

32 SHERWOOD AVE
EAST BRUNSWICK NJ
08816-2964
US

V. Phone/Fax

Practice location:
  • Phone: 973-949-7336
  • Fax:
Mailing address:
  • Phone: 732-567-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01234200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: