Provider Demographics
NPI:1174702500
Name:JACKAL, JOANNE (PHD, LCSW CASAC)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:JACKAL
Suffix:
Gender:F
Credentials:PHD, LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 UNDERCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1509
Mailing Address - Country:US
Mailing Address - Phone:973-564-7651
Mailing Address - Fax:973-564-7651
Practice Address - Street 1:7 UNDERCLIFF RD
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1509
Practice Address - Country:US
Practice Address - Phone:973-564-7651
Practice Address - Fax:973-564-7651
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2404101YA0400X
NJ44SC045479001041C0700X
NJ002612681041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool