Provider Demographics
NPI:1487880480
Name:SACKOR, JEROME B
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:B
Last Name:SACKOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7143 RUTLAND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1116
Mailing Address - Country:US
Mailing Address - Phone:215-722-2342
Mailing Address - Fax:
Practice Address - Street 1:1235 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5945
Practice Address - Country:US
Practice Address - Phone:215-735-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional