Provider Demographics
NPI:1215605977
Name:JACLYN DISABATO, LPC LLC
Entity Type:Organization
Organization Name:JACLYN DISABATO, LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DISABATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-876-3510
Mailing Address - Street 1:25 S MANOR CT
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3649
Mailing Address - Country:US
Mailing Address - Phone:973-476-3510
Mailing Address - Fax:
Practice Address - Street 1:1540 ROUTE 138 STE 201
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3765
Practice Address - Country:US
Practice Address - Phone:732-876-3510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty