Provider Demographics
NPI:1346964335
Name:HACKETT, KEVIN (LSW, LCADC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HACKETT
Suffix:
Gender:M
Credentials:LSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1829
Mailing Address - Country:US
Mailing Address - Phone:201-497-0130
Mailing Address - Fax:
Practice Address - Street 1:11 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1829
Practice Address - Country:US
Practice Address - Phone:201-497-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06817800104100000X
NJ37LC00364100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker