MEDICARE: CHERYL JACKO LPC, ACS, NCC

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
1	101YM0800X	Mental Health Counselor	37PC00780800	NJ

General Provider Information

NPI Number	:	1548908403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL JACKO LPC, ACS, NCC

Provider Business Mailing Address
First Line	:	PO BOX 5
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-0005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 BRIAR HILLS CIR
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3421
Country	:	US
Telephone Number	:	908-280-4149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2022
Last Update Date	:	07/23/2024

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