MEDICARE: JACKLIN AYDIN

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	101YP2500X	Professional Counselor	37PC00594100	NJ

General Provider Information

NPI Number	:	1871137257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKLIN AYDIN

Provider Business Mailing Address
First Line	:	312 AMBOY AVENUE
Second Line	:	2ND FLOOR
City	:	METUCHEN
State	:	NJ
Zip	:	08840
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 CARNATION DR
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-2507
Country	:	US
Telephone Number	:	201-644-6523
Fax Number	:

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

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	02/28/2023

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