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NPI Code Detail

MEDICARE: MR. ERIC GREGORY JACKLIN CAC, ICADC, MS, LADC

MEDICARE: MR. ERIC GREGORY JACKLIN CAC, ICADC, MS, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1235725607
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC GREGORY JACKLIN CAC, ICADC, MS, LADC
Provider Business Mailing Address
First Line : 1789 NEW BRITAIN AVE
Second Line :
City : FARMINGTON
State : CT
Zip : 06032-3317
Country : US
Telephone Number : 860-754-3507
Fax Number :
Provider Business Practice Location Address
First Line : 1789 NEW BRITAIN AVE
Second Line :
City : FARMINGTON
State : CT
Zip : 06032-3317
Country : US
Telephone Number : 860-754-3507
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2020
Last Update Date : 02/17/2023

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