Joanne Jackal, PH.D, LCSW CASAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC04547900 Issued in NJ

Practice address

7 Undercliff Rd
Millburn, NJ 07041-1509

Phone

(973) 564-7651

Fax

(973) 564-7651

NPI assigned

Nov 1, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193875200000",
    "number": "1174702500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 UNDERCLIFF RD",
            "city": "MILLBURN",
            "state": "NJ",
            "postal_code": "070411509",
            "telephone_number": "973-564-7651",
            "fax_number": "973-564-7651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 UNDERCLIFF RD",
            "city": "MILLBURN",
            "state": "NJ",
            "postal_code": "070411509",
            "telephone_number": "973-564-7651",
            "fax_number": "973-564-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKAL",
        "first_name": "JOANNE",
        "name_prefix": "Dr.",
        "credential": "PH.D, LCSW CASAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-01",
        "last_updated": "2007-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "2404",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC04547900",
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "NJ",
            "license": "00261268",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Millburn, NJ
• Providers in Millburn, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.